Hospital quality improves over time with EHRs, study finds

July 9, 2018, University of California, San Francisco
Credit: CC0 Public Domain

An examination of how the adoption of electronic health records (EHRs) affected the quality of hospital care between 2008 and 2013 found that mortality rates were initially higher among hospitals with more digital capabilities, but fell over time, as hospitals learned how to work with the technology and adopted new capabilities.

The study by researchers at UC San Francisco, the Harvard T. H. Chan School of Public Health and the University of Michigan, does not support the common viewpoint that EHRs are not improving clinical care, the researchers said, adding that their findings underscore the importance of allowing time for technology to prove its worth.

"In other industries, widespread digitization took a decade to realize improvements," said UCSF's Julia Adler-Millstein, Ph.D., an associate professor in the Department of Medicine and the Philip R. Lee Institute for Health Policy Studies, and senior author of the study, which is published July 9, 2018, in Health Affairs. "It's a major transformation of the healthcare system to go from paper to digital. We are seeing those rewards, but it has taken time and work."

All hospitals did not see equal benefits from digitization, however, and the trend was driven mainly by smaller and non-teaching hospitals. The researchers hypothesized this was because the larger and teaching hospitals had ongoing efforts to improve quality, and therefore had less room to improve with the adoption of records. In contrast, for smaller and non-teaching hospitals, EHR adoption may have represented a large, highly visible quality improvement initiative that also prompted broader quality efforts.

The research team examined data from 3,249 hospitals across the country, measuring quality by looking at 30-day for 15 common conditions for patients who were 65 years and older.

They selected a study timeframe beginning in 2008, because that is when national data was first collected about the adoption of EHRs. While many hospitals, particularly large and , already had EHR capabilities by then, many adopted new technology following passage of the HITECH Act—Health Information Technology for Economic and Clinical Health—which provided $30 billion in 2009 to stimulate a broad national investment in new technology.

Earlier research found mixed results on how EHRs affect the quality of care, but Adler-Milstein said that may be because these studies measured improvement based on a definition of EHR adoption that wasn't sufficiently nuanced. To better parse the differential effects of EHR adoption, the researchers examined three distinct phases: baseline EHR functions; the maturation of these baseline functions; and the adoption of new EHR functions.

"Hospitals implement functionality over time, because it's really hard to go from fully paper to fully electronic overnight," Adler-Milstein said. "We measured EHR adoption in a way that was truer to the way adoption likely occurred. As hospitals added functionalities over time, there was benefit from each of those new features."

Baseline adoption was associated with a 0.011 percentage point higher mortality rate per function. Over time, the maturation of these baseline functions was associated with a 0.09 percentage point lower mortality rate per function per year. The third category—adoption of new EHR functions—was associated with a 0.21 percentage point reduction in mortality rate per year per function.

"There's been a lot of frustration with EHRs," Adler-Milstein said. "Our study shows they are improving care. It just may not be as much as providers or policymakers wanted—or come as quickly, or as easily, as they would have liked."

Explore further: Program that paid hospitals to adopt electronic records delivers dramatic results

Related Stories

Program that paid hospitals to adopt electronic records delivers dramatic results

August 9, 2017
Incentives paid to hospitals to implement electronic health records appear to have paid off, with adoption rates 8 percentage points higher per year over five years for those that were eligible for the payments compared with ...

60 percent of peds hospitals have electronic health records

April 17, 2013
(HealthDay)—Since 2008 there has been an increase in the proportion of children's hospitals adopting electronic health records (EHRs), with EHRs in almost 60 percent of children's hospitals in 2011, according to research ...

EHR adoption increasing, but stage 2 criteria often not met

August 12, 2014
(HealthDay)—Most U.S. hospitals and office-based physicians have adopted electronic health records (EHR), according to two studies published in the August issue of Health Affairs.

Report highlights progress, challenges in health IT

September 1, 2014
(HealthDay)—Progress has been made toward widespread adoption of electronic health records (EHRs), although there are still barriers to adoption of advanced use of EHRs, according to a report published by the Robert Wood ...

Electronic health records don't increase Medicare fraud, study finds

July 9, 2014
(Medical Xpress)—Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher health care spending are unfounded, according to a study ...

Recommended for you

Eating iron-fortified grain improves students' attention, memory

July 18, 2018
Adolescent students in a rural school in India who consumed an iron-biofortified version of the grain pearl millet exhibited improved attention and memory compared to those who consumed conventional pearl millet, according ...

Lowering hospitals' Medicare costs proves difficult

July 18, 2018
A payment system that provides financial incentives for hospitals that reduce health-care costs for Medicare patients did not lower costs as intended, according to a new study led by Washington University School of Medicine ...

Vaping tied to blood clots—in mice

July 18, 2018
A new study involving mice raises another concern about the danger of e-cigarettes in humans after experiments showed that short-term exposure to the device's vapors appeared to increase the risk of clot formation.

People who tan in gyms tan more often, and more addictively, than others, new research shows

July 18, 2018
Gyms are places people go to get healthier. But nearly half the gyms in the U.S. contain a potentially addictive carcinogen—tanning beds, report UConn researchers in the July 18 issue of JAMA Dermatology.

Omega 3 supplements have little or no heart or vascular health benefit: review

July 17, 2018
New evidence published today shows there is little or no effect of omega 3 supplements on our risk of experiencing heart disease, stroke or death.

Study shows that people most affected by alcohol also most impacted by sleep deprivation

July 17, 2018
A team of researchers from the German Aerospace Center and Forschungszentrum Jülich has found that people who are most susceptible to alcohol intoxication are also most susceptible to cognitive problems due to sleep deprivation. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.