MIAMI BEACH — Adoption of an electronic health record system is associated with a consistent but modest increase in quality of hospital care, according to a survey of more than 4,800 acute care hospitals in the United States.
Acute myocardial infarction care and infection prevention improved significantly with electronic health records (EHRs), but the differences were small overall, Catherine DesRoches, Ph.D., said at the annual meeting of the Society of General Internal Medicine.
Electronic clinical reminders also had a significant but “extremely modest” effect.
Most previous studies of specific EHR functionalities and quality have focused on a small set of pioneering hospitals, said Dr. DesRoches, a survey scientist at the Institute for Health Policy at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School, both in Boston.
She and her colleagues surveyed all 4,840 acute care general medical and surgical hospitals as part of the American Hospital Association 2008 Annual Survey. They received answers from 3,049 hospital administrators, for a response rate of 63%.
The investigators asked administrators if they had an EHR, and if so, whether it was basic or comprehensive, based on 24 key clinical functionalities. Using data from the Hospital Quality Alliance and the Medicare Provider Analysis and Review, they linked EHR status to 30-day mortality and readmission for acute MI, heart failure, pneumonia, and prevention of surgical infections.
Hospitals with EHRs provided the right acute MI care 95.3% of the time, compared with 94.5% of the time for hospitals without a system. Also, acute MI mortality was modestly lower at EHR hospitals (14.9%) than at other institutions (15.8%). Mortality rates for heart failure and pneumonia were comparable between different hospital types, Dr. DesRoches said.
Similarly, hospitals with EHRs had modestly lower 30-day readmission rates for acute MI, heart failure, and pneumonia. The difference was significant only for patients with pneumonia (19.0% with EHRs versus 20.2% without).
“Our findings suggest EHR adoption is likely to be an important part of improving the efficiency and efficacy of our health care system, but just implementing [these] systems will not have a dramatic effect on care,” she said. “Finding ways to ensure effective use of these systems will be critical if we are to realize the potential of EHRs to improve the health and health care of all Americans.”
The $20 billion pledged by President Obama to improve health information technology “is a good start, and likely to get a good number of hospitals over the hump,” but will not help all institutions, especially those that are not currently ready for an EHR, said Dr. Ashish K. Jha, who presented survey results in a separate talk at the meeting.
Fewer than 10% of U.S. hospitals have EHRs, largely because of inadequate capital, he said.
Physician resistance, an insufficient information technology department, and ongoing costs also were impediments cited in the survey, according to Dr. Jha, an attending physician at Brigham and Women's Hospital in Boston who is also on the medicine faculty at Harvard Medical School.
Dr. Jha and his colleagues found 1.5% of hospitals had a comprehensive EHR system, defined as 24 key clinical functionalities across all major units of the hospital. Another 7.6% had a basic EHR system, defined as having 12 such features or having the 24 features adopted in fewer areas of the institution. Individual EHR functions varied, with 76% of institutions reporting they had widespread viewing of laboratory test results electronically, and only 12% saying they had fully implemented electronic physician notes.