Some good news about EHR adoption

I have spent a lot of time pointing out issues with EHRs and HIT. It’s nice to see some positive findings once in a while. From HSR, “EHR Adoption and Hospital Performance: Time-Related Effects“:

Objective: To assess whether, 5 years into the HITECH programs, national data reflect a consistent relationship between EHR adoption and hospital outcomes across three important dimensions of hospital performance.

Data Sources/Study Setting: Secondary data from the American Hospital Association and CMS (Hospital Compare and EHR Incentive Programs) for nonfederal, acute-care hospitals (2009–2012).

Study Design: We examined the relationship between EHR adoption and three hospital outcomes (process adherence, patient satisfaction, efficiency) using ordinary least squares models with hospital fixed effects. Time-related effects were assessed through comparing the impact of EHR adoption pre (2008/2009) versus post (2010/2011) meaningful use and by meaningful use attestation cohort (2011, 2012, 2013, Never). We used a continuous measure of hospital EHR adoption based on the proportion of electronic functions implemented.

Data Collection/Extraction Methods: We created a panel dataset with hospital-year observations.

The analysis is wonky, and to be honest, I’m not qualified to explain them in great detail. Instead, I’m going to give you the results and limitations, and let you think about what they mean. Let’s start with results:

  • Higher EHR adoption levels were associated with better adherence to process measures
  • They were also associated with better patient satisfaction
  • They were not significantly associated with efficiency
  • The positive relationships were stronger in 2010/2011 than in 2008/2009 (pre and post-HITECH)

Now some limitations:

  • Adherence to process measures was high all over, so it’s hard to tease out the EHR contribution. Most of the benefit may have been from low-performing hospitals to begin with who saw gains with EHRs
  • This isn’t an RCT. It’s possible that EHR adoption is related to improvements without causing them
  • Relatedly, it’s possible other unmeasured factors (like focused QI programs or payment incentives) are the cause of changes

Bottom line, EHR adoption was associated with some desired benefits. The magnitude is hard to translate, and it’s not assured that EHRs caused the improvements. But it’s still a positive result, and a bit of good news for those who support HIT and believe that HITECH was a good investment.


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