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Study: Patients with Electronic Health Records Experience Fewer In-Hospital Adverse Events

February 11, 2016
by Heather Landi
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A recent study funded by the Agency for Healthcare Research and Quality (AHRQ) indicates that cardiovascular, pneumonia and surgery patients exposed to a fully electronic health record (EHR) were between 17 and 30 percent less likely to experience in-hospital adverse events.

The study, which was recently published in The Journal of Patient Safety, examined the association of hospitals’ EHR adoption and occurrence rates of adverse events among exposed patients.

Amy Helwig, M.D., deputy director, AHRQ’s Center for Quality Improvement and Patient Safety and Edwin Lomotan, M.D., medical officer and chief of clinical informatics, AHRQ’s Center for Evidence and Practice Improvement, wrote a blog post about the results of the study.

“The findings suggest that hospitals with EHRs can provide what advocates have long claimed: better coordinated care from admission to discharge that reduces the risk of harm reaching patients,” Dr. Helwig and Dr. Lomotan wrote.

In the study, a research team led by AHRQ investigators analyzed patient discharges using patient medical record data from the 2012 and 2013 Medicare Patient Safety Monitoring System (MPSMS). The sample included patients age 18 and older that were hospitalized for one of 3 conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The database includes 21 hospital adverse event measures that are considered to be bellwethers of patient safety. Researchers grouped the measures into four categories: hospital-acquired infections, such as central line-associated bloodstream infections; adverse drug events; general events, such as falls and pressure ulcers; and post-procedural events, such as blood clots, according to the AHRQ blog post.

Helwig and Lomotan wrote that to assess the role of EHRs in preventing adverse events, the researchers measured to what extent care received by patients in the 1,351 hospitals was captured by a fully electronic EHR. Hospital care was categorized as either fully electronic, in which all physician notes, nursing assessments, problem lists, medication lists, discharge summaries, and provider orders are electronically generated; partially electronic, in which some, but not all, of those components are electronically generated and non-electronic, in which none of these components are present.

According to AHRQ, among the patients in the study sample, 347,281 exposures to adverse events occurred.  Of these exposures, 7,820 adverse events actually took place, resulting in a 2.25 percent occurrence rate of events for which patients were at risk. Occurrence rates were highest among patients hospitalized for pneumonia and lowest among patients requiring surgery.

Only 13 percent, or 5,876 patients, received care that was captured by a fully electronic EHR.  While these patients had lower odds of any adverse event, this association varied by medical condition and type of adverse event. 

“For example, patients hospitalized for pneumonia and exposed to a fully electronic EHR had 35 percent lower odds of adverse drug events, 34 percent lower odds of hospital-acquired infections, and 25 percent lower odds of general events. Among patients hospitalized for cardiovascular surgery, a fully electronic EHR was associated with 31 percent lower odds of post-procedural events and 21 percent fewer general events.  Fully electronic EHRs were associated with a 36 percent lower odds of hospital-acquired infections among patients hospitalized for surgery,” Helwig and Lomotan wrote.

According to AHRQ researchers, these findings build on the results of a previous study of Pennsylvania hospitals that used patient safety data drawn from the Pennsylvania Patient Safety Authority. “Hospitals using advanced EHRs had a 27 percent overall decline in these events, the authors found, fueled by a 30 percent drop in events due to medication errors,” Helwig and Lomotan wrote.

The AHRQ researchers noted that the study addresses some questions and raises others, such as why EHRs drive the decrease in odds of adverse events and why there isn’t a consistent impact.

“The study did not address which safety features of EHRs had been optimized or which applications had the greatest impact on reducing adverse events. As of today, most hospitals and clinicians have embraced specific EHR applications and we continue to see implementation of more quality and safety features.  EHRs can play a key role in preventing adverse events, and as this study suggests, adoption of EHRs can better manage the multiple tasks that prevent adverse events before they occur, keeping patients safer as a result,” the AHRQ researchers concluded.


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