scholarly journals Electronic health records systems and hospital clinical performance: a study of nationwide hospital data

2019 ◽  
Vol 26 (10) ◽  
pp. 999-1009 ◽  
Author(s):  
Neal Yuan ◽  
R Adams Dudley ◽  
W John Boscardin ◽  
Grace A Lin
Keyword(s):  
Electronic Health Records ◽  
Outcome Measures ◽  
Meaningful Use ◽  
Mortality Rates ◽  
National Study ◽  
Health Records ◽  
Process Measures ◽  
American Hospital ◽  
American Hospital Association ◽  
Electronic Health

Abstract Objective Electronic health records (EHRs) were expected to yield numerous benefits. However, early studies found mixed evidence of this. We sought to determine whether widespread adoption of modern EHRs in the US has improved clinical care. Methods We studied hospitals reporting performance measures from 2008–2015 in the Centers for Medicare and Medicaid Services Hospital Compare database that also reported having an EHR in the American Hospital Association 2015 IT supplement. Using interrupted time-series analysis, we examined the association of EHR implementation, EHR vendor, and Meaningful Use status with 11 process measures and 30-day hospital readmission and mortality rates for heart failure, pneumonia, and acute myocardial infarction. Results A total of 1246 hospitals contributed 8222 hospital-years. Compared to hospitals without EHRs, hospitals with EHRs had significant improvements over time on 5 of 11 process measures. There were no substantial differences in readmission or mortality rates. Hospitals with CPSI EHR systems performed worse on several process and outcome measures. Otherwise, we found no substantial improvements in process measures or condition-specific outcomes by duration of EHR use, EHR vendor, or a hospital’s Meaningful Use Stage 1 or Stage 2 status. Conclusion In this national study of hospitals with modern EHRs, EHR use was associated with better process of care measure performance but did not improve condition-specific readmission or mortality rates regardless of duration of EHR use, vendor choice, or Meaningful Use status. Further research is required to understand why EHRs have yet to improve standard outcome measures and how to better realize the potential benefits of EHR systems.

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Karen E Joynt ◽  
Deepak L Bhatt ◽  
Lee H Schwamm ◽  
Ying Xian ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Electronic Health Records ◽  
Clinical Outcomes ◽  
Quality Care ◽  
Health Records ◽  
American Hospital ◽  
American Hospital Association ◽  
Electronic Health

Background: Electronic Health Records (EHRs) may be a key tool for improving the quality of healthcare. They may be particularly important for conditions such as ischemic stroke, in which guidelines are rapidly evolving and timely care of the patient is critical. Methods: We used data from 1,236 hospitals participating in Get With The Guidelines-Stroke, representing 626,473 ischemic strokes between 2007 and 2010, and linked this with the American Hospital Association annual survey to characterize which study hospitals had an EHR. We conducted regression analyses to determine whether hospitals with an EHR demonstrated better performance on quality metrics, length of stay, discharge to home, and mortality. Results: 511 hospitals had an EHR by the end of the study period. Stroke patients at hospitals with EHRs were younger, more often male and non-white, and had a lower burden of medical comorbidities. Hospitals with EHRs were larger, and more often teaching hospitals and stroke centers than hospitals without EHRs. In unadjusted analyses, patients at hospitals with EHRs were more likely to receive “all-or-none” care (87.9% versus 82.6%, p<0.001), and less likely to have a length of stay over 4 days (42.4% versus 43.9%, p<0.001). However, there were no differences in discharge to a site other than home (50.9% versus 51.1%, p=0.12) or in-hospital mortality (5.3% versus 5.2%, p=0.40). In multivariate analyses, after controlling for patient and hospital characteristics, the presence of an EHR was no longer associated with better quality care, and continued to have no association with clinical outcomes (Table). Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.

scholarly journals Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities

2015 ◽  
Vol 3 (3) ◽  
pp. e30 ◽  
Author(s):  
Sarah Patricia Slight ◽  
Eta S Berner ◽  
William Galanter ◽  
Stanley Huff ◽  
Bruce L Lambert ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Meaningful Use ◽  
Health Records ◽  
Electronic Health

scholarly journals Pilot Study of Meaningful Use of Electronic Health Records in Radiation Oncology

2012 ◽  
Vol 8 (4) ◽  
pp. 219-223 ◽  
Author(s):  
Xinglei Shen ◽  
Adam P. Dicker ◽  
Laura Doyle ◽  
Timothy N. Showalter ◽  
Amy S. Harrison ◽  
...  
Keyword(s):  
Pilot Study ◽  
Electronic Health Records ◽  
Electronic Health Record ◽  
Radiation Oncology ◽  
Meaningful Use ◽  
Health Record ◽  
Health Records ◽  
Widespread Adoption ◽  
Electronic Health

Most large academic radiation oncology practices have incorporated electronic health record systems into practice and plan to meet meaningful use requirements. Further work should focus on needs of smaller practices, and specific guidelines may improve widespread adoption.

Association Between Meaningful Use and Florida Counties’ COVID-19 Case and Death Rates Among Medicaid Providers (Preprint)

2021 ◽  
Author(s):  
Katherine Freeman ◽  
Judith P. Monestime
Keyword(s):  
Electronic Health Records ◽  
Cumulative Incidence ◽  
Meaningful Use ◽  
County Level ◽  
Cross Sectional ◽  
Health Records ◽  
Death Rates ◽  
Public Health Reporting ◽  
Electronic Health ◽  
Population Demographic

BACKGROUND Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated the adoption of Meaningful Use of Electronic Health Records (EHRs) among Medicaid providers, only about half achieve Meaningful Use. Furthermore, the validity of public health reporting of COVID-19 outcomes, which relies on Meaningful Use advanced functions, remains unknown. OBJECTIVE This study aims to examine the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level incidence rates of COVID-19 cases and deaths, accounting for county-level race/ethnicity, unemployment, income, prevalence of respiratory diseases, age, poverty, and healthcare environment. METHODS This cross-sectional ecologic study examined the association between Meaningful Use achievement by Medicaid providers and COVID-19 cases and death rates from 67 Florida counties as of November 19, 2020. Provider information was obtained from the publicly available database from the Florida Medicaid Promoting Interoperability Program, formerly Electronic Health Record Incentive Program. The database includes the Area Health Resources File, capturing provider characteristics and population demographic and socioeconomic characteristics at the county level. Cumulative COVID-19 cases and deaths were obtained from the Florida Department of Health Open Data (FDOH) for zip codes which were aggregated by county. Rates were obtained by dividing cumulative incidence or prevalence by the U.S. Census County population. RESULTS As of November 19, 2020, the cumulative incidence rate of COVID-19 deaths was significantly different between Medicaid providers who achieved Meaningful Use and those who did not (P=.0131), with relatively more deaths reported for those not achieving Meaningful Use. County-level characteristics associated with increased COVID-19 death rates in hierarchical models include greater concentrations of persons of African American or Black race (P<.0001), lower median household income (P<.0001), higher unemployment (P<.0001), and higher concentrations of those living in poverty (P<.0001) and without health insurance (P<.0001). CONCLUSIONS Although Federal subsidies successfully influenced the adoption of Electronic Health Records, our findings suggest an emerging further digital "advanced use" divide among patients cared for by Medicaid providers. Policy interventions need to be reevaluated to address disparities in COVID-19 clinical outcomes which appear exacerbated by the limited use of advanced Electronic Health Records functions. CLINICALTRIAL not applicable

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