EHRs tied to lower hospital mortality, but only with time and experience
- EHR adoption can help to reduce 30-day mortality rates, but only after systems have had time to mature, according to a new analysis in Health Affairs.
- Using data from 2008-2013, the researchers found a 0.11% rise in mortality rate per function during baseline adoption. By contrast, longer use was associated with a 0.09% decline per year per function, and each new function adopted resulted in a further 0.21% drop in mortality rate.
- Small and nonteaching hospitals showed the biggest gains, with new EHR functions yielding 0.26% and 0.21% lower mortality rates, respectively.
The study authors write that their results show the "relationship between EHR adoption and performance is not as simple and straightforward as, ‘Does it work?’ The relationship varies not only by hospital characteristics but also with time.”
Concerns about EHRs persist, including the time they require to input data and the real, albeit rare, potential to create errors. In a recent analysis of 1.7 million safety reports, just 1,956 (0.11%) named an EHR vendor or product and potential patient harm and 557 (0.03%) pointed to EHR usability as a factor in the problem.
EHRs have also been linked to physician fatigue and burnout, which can increase the likelihood of medical errors. In a Medscape survey earlier this year, nearly two-thirds of physicians reported feeling burned out, depressed or both. The chief culprits were documentation (56%) and increased computer time with EHRs (24%).
Still, the new study suggests EHRs are worth the trouble and can have a positive impact on patient outcomes — with time and for particular types of hospitals.
Like with other health IT tools, the benefits of EHR adoption may grow with time and experience, the authors say. Performance-related gains are more likely to show up where there is strong support for EHRs and EHR-enabled quality improvement efforts.
The fact that greater gains were seen in small and nonteaching hospitals may be because large and teaching hospitals were implementing quality improvements prior to adopting EHRs — thus lessening their positive impact. “For small and nonteaching hospitals, EHR adoption may have represented a large, highly visible quality improvement initiative that also prompted broader conversations about quality,” the authors write.
Another explanation could be that small and nonteaching hospitals have limited resources, resulting in poorer baseline implementation but allowing for greater improvement over time, they add.
Studies have shown similar differences in EHR use among large and small medical practices. In a recent Black Book survey, nearly 90% of practices with six or fewer doctors weren’t using advanced EHR features such as clinical decision support and electronic messaging. By contrast, the majority of large practices reported using advanced features frequently, and 30% said they plan to replace their current EHR by 2021.