Study: New EHR Go-Lives Don’t Impede Patient Care

Despite concerns that the implementation of electronic health records (EHRs) might unfavorably impact patient care during the technology transition period, no negative short-term affects were found for 17 U.S. hospitals, according to new research published in the BMJ.

Researchers in multiple medical institutions in the Boston area looked at Medicare patients admitted to 17 study hospitals with a verifiable “go-live” date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region. The study’s authors note that while most U.S. hospitals have adopted at least basic EHRs, increasing numbers of hospitals and physician practices are also switching EHRs, likely in part to reach higher levels of meaningful use.

As such, the researchers theorized, “Implementing a new EHR or switching to another is likely one of the most disruptive predictable events a hospital can experience, affecting practically every employee and workflow at a hospital. In the period immediately after implementation, workflow disruptions created by technologies like electronic order entry can give rise to a wide array of unintended consequences, such as inefficient workarounds, disruptions in continuity of care, and other electronically enabled errors.”

They continued, “Quality could also suffer because providers might be distracted by the abrupt change in how they retrieve test results, consultation notes, and prior admission/discharge documentation, and how they document patient care. Not surprisingly, many have raised concerns that EHR implementation or switching may adversely impact patient safety and quality in the weeks to months after transition. One hospital reported a more than doubling of mortality in the five months after activating a new computerized physician order entry module, a key component of EHR implementation.”

As such, the study included the short-term association of EHR implementation with 30 day mortality, 30 day readmissions, and safety events in a sample of hospitals that adopted a new inpatient EHR system in 2011-12. The study focused on hospitals that transitioned all inpatient care to a new EHR system in a single day, often referred to as the go-live date, which offers a quasi-experiment of how quality and safety of inpatient care are affected after transition. All but three of the 17 study hospitals implemented EHRs using software from Epic Systems.

Indeed, the researchers observed no overall negative association between short-term inpatient outcomes among Medicare enrollees and EHR implementation in a sample of 17 hospitals. “Our findings should be reassuring to hospitals and physicians who are considering or planning the implementation of EHRs,” the authors noted.

The authors did note a broad variation in patient outcomes in the post-implementation period across the 17 individual hospitals implementing EHRs, however. To this end, they suggested that many EHR implementations might be executed poorly, pointing out that many anecdotes exist of poor EHR roll-outs that have led to institutional turmoil. “Whether the variation across hospitals we observed reflects the effectiveness of EHR implementation at each institution is unclear given the findings of our sensitivity analyses, with similar differences in outcomes in hospitals where no EHR was implemented. These results illustrate that studying the effect of an EHR intervention at any single hospital is problematic,” they concluded.