Over the past decade, there has been significant national investment in electronic health record (EHR) systems at U.S. hospitals, which was expected to result in improved quality and efficiency of care. However, evidence linking EHR adoption to better care is mixed, according to medical researchers.
What’s more, these studies have caused many hospitals to question the value of their investment in EHRs and policy makers to wonder whether benefits from the investment of federal dollars are being realized, researchers have noted.
However, a study recently published in Health Affairs suggests that EHR adoption has a positive impact on mortality rates, though it takes time for this impact to be realized.
In order to better understand the relationship between EHR adoption and healthcare outcomes, researchers sought to examine EHR adoption through the common incremental approach as new functionalities are added over time at U.S. hospitals, and the impact of that incremental adoption and maturation on hospital performance—specifically 30-day mortality rates.
The study was led by Sunny Lin, a doctoral candidate in the Department of Health Management and Policy at the University of Michigan; Ashish Jha, the K.T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health, and director of the Harvard Global Health Institute; and Julia Adler-Milstein, an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, at the University of California San Francisco.
The researchers used Medicare hospital claims data for the period 2008–2013 to examine annual measures of hospital EHR adoption, characteristics and mortality performance in order to assess the relationship between EHR adoption and 30-day mortality rates. For the study, researchers founded on the baseline level of EHR adoption, the maturation of the baseline functions over time, and the adoption of new EHR functions.
In the study sample of 3,249 hospitals, the mean base-line number of basic EHR functions was 5.7, and the mean number of new functions adopted per year was 0.6. The average baseline risk-adjusted thirty-day mortality rate was 13.46 deaths per 100 admission, according to the study.
The researchers found that the number of base-line EHR functions was associated with higher 30-day mortality rates, as baseline adoption was associated with a 0.11-percentage-point higher rate per function. Over time, maturation of the baseline functions was associated with a 0.09-percentage-point reduction in mortality rate per year per function. Adding new EHR functions over time was also associated with lower mortality rates, the researchers found, as each new function adopted in the study period was associated with a 0.21-percentage-point reduction in mortality rate per year per function.
Small and non-teaching hospitals realizing greater gains, as these institutions experienced worse performance with a greater number of baseline functions but improved performance from the maturation effect and new function adoption, the study states.
“Difference-in-differences in predicted annual changes in thirty-day mortality rates showed that average adopters performed significantly better than nonadopters, with 0.67 fewer deaths per 100 admissions. When we examined predicted changes in mortality rates by hospital characteristics, we found that average adopters performed significantly better than nonadopters if they were urban/suburban or rural, small or medium, non-teaching, and safety-net or non-safety-net. Differences in mortality rates for average adopters versus nonadopters were not significant for large hospitals and major or minor teaching hospitals,” the study authors wrote.
The findings suggest that EHR adoption affects performance improvement through multiple pathways and that when EHR adoption is measured, the baseline level, the maturation effect of baseline functions, and the adoption of new functions over time, should be taken into account, the study authors wrote.
Overall, the study suggests that national investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time, the study authors noted. “This result is consistent with theories on adoption and use of information technology that suggest that time plays an important role in the integration of technology into standard practice and in resulting performance improvement,” the study authors wrote. “Prior research on the maturation of health IT suggests that the benefit of EHR adoption and health information exchange may increase over time. Therefore, hospitals should expect that most performance-related gains from EHR adoption will take time to emerge and that these effects may be maximized when coupled with greater EHR support and EHR-enabled quality improvement efforts.”