(Reuters Health)—Hospitals that switch from paper to electronic health records may eventually see lower death rates than they had before, but a U.S. study also suggests that fatalities may first increase as the transition gets underway.
Researchers examined the degree of digitization and 30-day death rates for patients age 65 and older at 3,249 hospitals nationwide from 2008 to 2013. While many academic hospitals already used electronic health records at the start of the study period, many other hospitals didn’t make this transition until after 2009 when the U.S. government set aside $30 billion to encourage investment in health technology, researchers note in Health Affairs, online July 9.
At the start of the study period, for every electronic health function – such as medication lists, computerized prescribing, and clinical decision support – that was already fully implemented, hospitals had 0.11 additional deaths per 100 patient admissions, or a 0.11 percentage-point higher mortality rate, researchers found.
Over time, however, each of the functions adopted at the start of the study period were associated with a 0.09 percentage-point drop in annual death rates. And, every new function added during the study period was also associated with a 0.21 percentage-point reduction in annual death rates.
“Our overall findings were driven by what was happening in small and non-teaching hospitals,” and not at the academic medical centers, said senior study author Julia Adler-Milstein of the University of California, San Francisco.
“So, for patients considering care at these types of hospitals, it might be good to know how digital they are and then, if there is a need to receive hospital care and the patient has a say in where that occurs, pick a hospital that is more digital and has been digital for longer,” Adler-Milstein said by email.
While the study wasn’t a controlled experiment designed to prove whether or how converting to electronic health records (EHR) directly impacts hospital death rates, the study team speculates that the larger and academic hospitals had ongoing quality improvement efforts that left less room to show mortality benefits when they went digital.
For smaller community hospitals, however, adopting electronic health records might have made a bigger difference in improving the quality of care.
In contrast, for smaller and non-teaching hospitals, EHR adoption may have represented a large, highly visible quality improvement initiative that also prompted broader quality efforts.
Hospitals can take steps to make the transition as smooth as possible, said Ann Kutney-Lee, a researcher at the University of Pennsylvania School of Nursing in Philadelphia who wasn’t involved in the study.
“The initial stages of adopting and implementing EHRs can cause unintended consequences and significant disruptions in clinical workflow processes that can affect the delivery of safe patient care, including – but not limited to – communication between providers, access to patient records and test results, medication order entry, and medication administration records,” Kutney-Lee said by email.
“To avoid these potential negative effects, hospitals should ensure that adequate supports and resources are in place prior to and throughout the time of adoption or modification of an EHR system, and that contingency plans are in place for when the EHR is not working,” she added.
While the results add to evidence suggesting that there’s an adjustment period with new technology, today nearly all U.S. hospitals have adopted electronic health records, said A. Jay Holmgren, a researcher at Harvard Business School in Boston who wasn’t involved in the study.
“EHR adoption was a big shock in many ways to the practice of medicine,” Holmgren said by email. “It isn’t surprising that there was an initial learning curve for hospitals.”
With the transition now complete at most hospitals, “patients have little to worry over with regards to EHR adoption and choosing a hospital,” Holmgren said.
The study findings should reassure patients that they ultimately benefit from electronic records, said Dean Sittig, a researcher at the University of Texas Health Science Center at Houston who wasn’t involved in the study.
“Implementing EHRs is difficult and time consuming, but well worth the effort,” Sittig said by email. “Gains are made slowly but surely over time.”
- Lin SC, Jha AK, Adler-Milstein J. Electronic Health Records Associated With Lower Hospital Mortality After Systems Have Time To Mature.Health Aff (Millwood). 2018 Jul;37(7):1128-1135.