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New England Journal of Medicine 06/2012; 366(24):2243-5. · 53.30 Impact Factor
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ABSTRACT: The federal government is currently offering bonus payments through Medicare and Medicaid to hospitals, physicians, and other eligible health professionals who meet new standards for "meaningful use" of health information technology. Whether these incentives will improve care, reduce errors, and improve patient safety as intended remains uncertain. We sought to partially fill this knowledge gap by evaluating the relationship between the use of electronic medication order entry and hospital mortality. Our results suggest that the initial meaningful-use threshold for hospitals-which requires using electronic orders for at least 30 percent of eligible patients-is probably too low to have a significant impact on deaths from heart failure and heart attack among hospitalized Medicare beneficiaries. However, the proposed threshold for the next stage of the program-using the orders for at least 60 percent of patients, a rate some stakeholders have said is too high-is more consistently associated with lower mortality. Our results suggest that the higher standard that will probably follow in the second stage of meaningful-use regulations would be more likely than the first-stage standard to produce the improved patient outcomes at the heart of the federal health information technology initiative.
Health Affairs 09/2011; 30(10):2005-12. · 4.31 Impact Factor
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ABSTRACT: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 offers significant financial incentives to hospitals that can demonstrate "meaningful use" of EHRs. Reduced hospital readmissions are an expected outcome of improved care coordination. Increased use of HIT, and in particular participation in HIE are touted as ways to improve coordination of care. In a 2007 national sample of US hospitals, we evaluated the association between hospitals' HIE and HIT use and 30-day risk adjusted readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. We found that hospital participation in HIE was not associated with lower hospital readmission rates; however, high levels of electronic documentation (an aspect of HIT use) were associated with modest reductions in readmission for heart failure (24.6% vs. 24.1%, P=.02) and pneumonia (18.4% vs. 17.9%, P=.003). More detailed data on participation in HIE are necessary to conduct more robust assessment of the relationship between HIE and hospital readmission rates.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:644-53.
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ABSTRACT: To estimate the relationship between quality improvement and electronic health record (EHR) adoption in US hospitals.
National cohort study based on primary survey data about hospital EHR capability collected in 2003 and 2006 and on publicly reported hospital quality data for 2004 and 2007.
Difference-in-differences regression analysis to assess the relationship between EHR adoption and quality improvement for acute myocardial infarction, heart failure, and pneumonia care.
Availability of a basic EHR was associated with a significant increase in quality improvement for heart failure (additional improvement, 2.6%; 95% confidence interval [CI], 1.0%-4.1%). However, adoption of advanced EHR capabilities was associated with significant decreases in quality improvement for acute myocardial infarction and heart failure. We observed 0.9% (95% CI, -1.7% to -0.1%) less improvement for acute myocardial infarction quality scores and 3.0% (95% CI, -5.2% to -0.8%) less improvement for heart failure quality scores among hospitals that newly adopted an advanced EHR, and 1.2% (95% CI, -2.0% to -0.3%) less improvement for acute myocardial infarction quality scores and 2.8% (95% CI, -5.4% to -0.3%) less improvement for heart failure quality scores among hospitals that upgraded their basic EHR.
Mixed results suggest that current practices for implementation and use of EHRs have had a limited effect on quality improvement in US hospitals. However, potential "ceiling effects" limit the ability of existing measures to assess the effect that EHRs have had on hospital quality. In addition to the development of standard criteria for EHR functionality and use, standard measures of the effect of EHRs on quality are needed.
The American journal of managed care 12/2010; 16(12 Suppl HIT):SP64-71. · 2.46 Impact Factor
