Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes

Murphy, Zachary; Wang, Jiangxia; Boland, Michael V.

doi:10.1001/jamanetworkopen.2020.12529

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…It will be important to study the impact of MU attestation on the ability to achieve these intended outcomes envisioned by the Affordable Care Act (ACA) [20] and HITECH Act to direct policies and implementation related to the next phases of Promoting Interoperability Programs. Our results are consistent with the literature and suggests that critical evaluation is needed for EHR implementation related to specific patient safety metrics [11]. The most recently published study in 2020 evaluated the 7 separate MU performance measures to determine the association with achieving gains in patient safety.…”

Section: Discussionsupporting

confidence: 89%

“…One study found that EHRs and HITs had little to no association with hospital readmission rates [13]. To our knowledge, only three studies investigate the impact of MU on patient safety outcomes [11,14,15]. Another study found that Stage 1 MU capable EHR systems were associated with improvements on 3 of 8 patient safety measures with 7% to 11% lower rates of adverse events [15].…”

Section: Of 10mentioning

confidence: 99%

“…Some studies show EHRs have achieved gains in patient satisfaction, clinical outcomes, risk management, and decision support [2][3][4][5][6][7]. However, the literature has provided mixed empirical evidence regarding the ability of EHRs to achieve improvements in other outcomes, including patient safety, quality, and cost-efficiency [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety

Trout

Chen

Wilson

et al. 2022

IJERPH

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The HITECH Act aimed to leverage Electronic Health Records (EHRs) to improve efficiency, quality, and patient safety. Patient safety and EHR use have been understudied, making it difficult to determine if EHRs improve patient safety. The objective of this study was to determine the impact of EHRs and attesting to Meaningful Use (MU) on Patient Safety Indicators (PSIs). A multivariate regression analysis was performed using a generalized linear model method to examine the impact of EHR use on PSIs. Fully implemented EHRs not attesting to MU had a positive impact on three PSIs, and hospitals that attested to MU had a positive impact on two. Attesting to MU or having a fully implemented EHR were not drivers of PSI-90 composite score, suggesting that hospitals may not see significant differences in patient safety with the use of EHR systems as hospitals move towards pay-for-performance models. Policy and practice may want to focus on defining metrics and PSIs that are highly preventable to avoid penalizing hospitals through reimbursement, and work toward adopting advanced analytics to better leverage EHR data. These findings will assist hospital leaders to find strategies to better leverage EHRs, rather than relying on achieving benchmarks of MU objectives.

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Section: Discussionsupporting

confidence: 89%

Section: Of 10mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety

Trout

Chen

Wilson

et al. 2022

IJERPH

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“…The benefits of EHRs include improved access to records, the facilitation of communication, increased quality of patient-centered care through clinical decision support and safety engineering, cost savings, and improved data management for medical research and education. [ 2 , 3 ] In a previous study, we found that the adoption level of EHRs may be related to healthcare quality, with improved quality in the full-EHR stage compared with the no-EHR stage. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Restricted use of copy and paste in electronic health records potentially improves healthcare quality

Cheng

et al. 2022

Medicine

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The copy-and-paste feature is commonly used for clinical documentation, and a policy is needed to reduce overdocumentation. We aimed to determine if the restricted use of copy and paste by doctors could improve inpatient healthcare quality. Clinical documentation in an inpatient dataset compiled from 2016 to 2018 was used. Copied-and-pasted text was detected in word templates using natural language programming with a threshold of 70%. The prevalence of copying and pasting after the policy introduction was accessed by segmented regression for trend analysis. The rate of readmission for the same disease within 14 days was assessed to evaluate inpatient healthcare quality, and the completion of discharge summary notes within 3 days was assessed to determine the timeliness of note completion. The relationships between these factors were used cross-correlation to detect lag effect. Poisson regression was performed to identify the relative effect of the copy and paste restriction policy on the 14-day readmission rate or the discharge note completion rate within 3 days. The prevalence of copying and pasting initially decreased, then increased, and then flatly decreased. The cross-correlation results showed a significant correlation between the prevalence of copied-and-pasted text and the 14-day readmission rate ( P < .001) and a relative risk of 1.105 ( P < .005), with a one-month lag. The discharge note completion rate initially decreased and not affected long term after restriction policy. Appropriate policies to restrict the use of copying and pasting can lead to improvements in inpatient healthcare quality. Prospective research with cost analysis is needed.

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“…6 However, some studies have demonstrated that EHR implementation is not robustly associated with improvements in care quality. 7,8 Many physicians see the value of EHRs and most would not want to return to paper-based medical records. 9 However, despite these positive outcomes, EHRs have been linked to lower patient satisfaction and a significant increase in staff turnover.…”

Section: Introductionmentioning

confidence: 99%

Which Strategies Improve Physicians' Experience with Health Information Technology?

et al. 2021

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Objectives While electronic health records (EHRs) have improved billing efficiency and note legibility, they may also disrupt clinical workflows, affect patient interactions, and contribute to physician burnout. This study aimed to identify effective strategies, as reported by physicians, to mitigate these EHR shortcomings. Methods The Rhode Island Department of Health administers a health information technology (HIT) survey biennially to all physicians in active practice statewide. The 2019 survey asked physicians about strategies implemented personally or by their practice to improve their experience working with HIT. Physicians who identified at least one strategy were then asked if each implemented strategy was “actually useful.” Results The 2019 survey was administered to 4,266 physicians, with a response rate of 43%. Both office- and hospital-based physicians most commonly reported that their practices had implemented voice-recognition dictation software (48 and 68%, respectively). Office- and hospital-based physicians identified self-care as the most commonly implemented personal change (48 and 47%, respectively). However, 26% of office-based and 15% of hospital-based physicians reported reducing clinical hours or working part-time to improve their experience working with HIT. The strategies identified as “actually useful” varied by practice setting and were not always the most widely implemented approaches. Conclusion Most physicians reported that both they personally and their practices had implemented strategies to improve their experience with HIT. Physicians found some of these strategies more helpful than others, and the strategies identified as most useful differed between office- and hospital-based physicians. From a workforce and access perspective, prioritizing strategies that physicians find “actually useful” is critical, as many physicians in both settings reported reducing clinical hours to improve their experience.

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Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes

Abstract: This cross-sectional quality improvement study assesses whether electronic health record implementation above meaningful use thresholds is associated with changes in hospital patient satisfaction, efficiency, and safety.

Cited by 9 publications

References 27 publications

The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety

The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety

Restricted use of copy and paste in electronic health records potentially improves healthcare quality

Which Strategies Improve Physicians' Experience with Health Information Technology?

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