Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.

Abstract

SummaryBackground: Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors. Objective: To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without. Methods: This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias. Results: The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 -1.3) Conclusions: Implementation of comprehensive electronic health record systems does not necessarily improve a hospital's ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers.

What to expect from electronic patient record system implementation: lessons learned from published evidence

“…However, laboratory testing, medication administration and radiologic imaging all showed sustained increase-post-implementation 82. In a further study, no difference was found in measures of operational performance,83 and others also report no effect on outpatient volumes84 or readmission rates 85. The most recent emergency department study reported no differences in volume, admissions, or transfers but increased length of stay until 1 year later 86…”

Vantagens Da Implantação Do Prontuário Eletrônico Na Segurança Do Paciente E Na Otimização Do Trabalho Do Farmacêutico Hospitalar

“…O PEP fornece também estrutura para melhoras na segurança do paciente e na pontualidade do atendimento (11), favorecendo mudanças culturais e no fluxo de trabalho das instituições hospitalares. Além disso, as reduções de erros de transcrição e comunicação dos resultados, e intervenções a tempo suportam a visão que o PEP proporciona um bom retorno sobre o investimento, mesmo que o tempo e os custos com a internação não diminuam significativamente (11,13).…”