Electronic Health Record Adoption and Rates of In-hospital Adverse Events

Furukawa, Michael F.; Eldridge, Noel; Wang, Yun; Metersky, Mark L.

doi:10.1097/pts.0000000000000257

Cited by 30 publications

(19 citation statements)

References 31 publications

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“…Although not conclusive, studies are beginning to reveal an association between EHR use and improved guideline adherence 15 and a decreased incidence of adverse effects due to medical errors. 16,17 The time physicians devoted to chart review may be early evidence of providers using the EHR to improve the care they deliver. Emerging technologies, including voice commands to retrieve chart summary information 18 and mobile versions of the EHR, 19 may help to better balance time spent foraging records with time spent directly interacting with patients.…”

Section: Discussionmentioning

confidence: 99%

Pediatrician Electronic Health Record Time Use for Outpatient Encounters

Overhage

Johnson

2020

Pediatrics

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BACKGROUND: The time providers spend using their electronic health records (EHRs) delivering care and its potential impact on patient care are of concern for the health care system. In studies to date, researchers have focused on providers who primarily care for adults. Scant information exists for pediatricians. Given this gap, it is important to quantify EHR activity for this group. METHODS: We studied pediatricians practicing in US-based ambulatory practices using the Cerner Millennium EHR by extracting data from software log files in the Lights On Network for the calendar year 2018 and summarizing the time spent on each of 13 clinically-focused EHR functions according to clinical specialty. RESULTS: Our data included .20 million encounters by almost 30 thousand physicians from 417 health systems. Pediatric physicians spent an average of 16 minutes per encounter using their EHR. Chart review (31%), documentation (31%), and ordering (13%) functions accounted for most of the time. The distribution of time spent by providers using their EHR is highly variable within subspecialty but is similar across specialties. Because of data limitations, we were unable to examine geographic or health system-specific variation. CONCLUSIONS: Pediatricians, like physicians who care for adults, spend a large portion of their day using their EHR. Additionally, although chart review and documentation accounted for 62% of the activity, as in previously published studies, in our study, we found that chart review accounted for half of that time. Wide variation suggests opportunities to optimize both the processes of entering information and searching for patient data within the EHR. WHAT'S KNOWN ON THIS SUBJECT: Although .94% of pediatricians in the United States use an electronic health record (EHR), we know little about how much time they devote to using this vital tool and how time varies by subspecialty. WHAT THIS STUDY ADDS: Pediatricians average 16 minutes per encounter using their EHR, with record review and documentation accounting for 62% of the time. These data provide a baseline from which we can judge the impact of innovations or policy-related EHR changes.

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Section: Discussionmentioning

confidence: 99%

Pediatrician Electronic Health Record Time Use for Outpatient Encounters

Overhage

Johnson

2020

Pediatrics

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“…2 Over the same 7-year period, the number of hospitals implementing comprehensive EHR systems that have more advanced functionalities, such as clinical decision support, grew from less than 2 to 40%. 2 While some evidence suggests that higher levels of EHR adoption produce safer and higher quality care, [3][4][5][6][7] a growing body of literature has documented unintended negative consequences of the technology, 8,9 including disruptions in clinical workflows and usability concerns that may negatively affect quality of care and patient safety. [10][11][12] These system issues may disproportionally impact the work of nurses who are among the highest EHR users in hospitals.…”

Section: Background and Significancementioning

confidence: 99%

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment

et al. 2019

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Background Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. Objective The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety. Methods This study was a secondary analysis of nurse and hospital survey data. Unadjusted and adjusted logistic regression models were used to assess the relationship between EHR adoption level, work environment, and a set of EHR usability and quality/safety outcomes. The sample included 12,377 nurses working in 353 hospitals. Results In fully adjusted models, comprehensive EHR adoption was associated with lower odds of nurses reporting poor usability outcomes, such as dissatisfaction with the system (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.61–0.92). The work environment was associated with all usability outcomes with nurses in better environments being less likely to report negatively. Comprehensive EHRs (OR: 0.83; 95% CI: 0.71–0.96) and better work environments (OR: 0.47; 95% CI: 0.42–0.52) were associated with lower odds of nurses reporting fair/poor quality of care, while poor patient safety grade was associated with the work environment (OR: 0.50; 95% CI: 0.46–0.54), but not EHR adoption level. Conclusion Our findings suggest that adoption of a comprehensive EHR is associated with more positive usability ratings and higher quality of care. We also found that—independent of EHR adoption level—the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.

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“…Considerable resources have been allocated to improve patient safety since these reports on patient harm, with significant advances achieved in safety research, quality improvement initiatives, policy, health information technology, reimbursement strategies, and accreditation standards. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 In certain clinical domains, such as hospital-acquired infections and transitions of care between teams and patient care units, there have been several reports suggesting notable nationwide improvements in outcomes. 11 , 12 , 13 It is unclear, however, if improvements in such proxy measures of overall patient safety have translated into mortality improvements across all types of adverse effects of medical treatment (AEMT) over time.…”

Section: Introductionmentioning

confidence: 99%

Association of Adverse Effects of Medical Treatment With Mortality in the United States

et al. 2019

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Key Points Question How has mortality associated with adverse effects of medical treatment in the United States changed over time, by state, age, and sex? Findings In this cohort study, there was a decrease in the national age-standardized mortality rate associated with adverse effects of medical treatment in the United States between 1990 and 2016. Although no differences by sex were observed, increased mortality due to adverse effects of medical treatment was associated with advancing age, and geographic variability was noted. Meaning Global Burden of Disease 2016 results suggest that mortality associated with the adverse effects of medical treatment has decreased modestly over the past 25 years, and although the degree of improvement varies by state, it appears that an increased burden of adverse effects of medical treatment on aging populations continues to affect the US health system.

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Electronic Health Record Adoption and Rates of In-hospital Adverse Events

Abstract: Cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.

Cited by 30 publications

References 31 publications

Pediatrician Electronic Health Record Time Use for Outpatient Encounters

Pediatrician Electronic Health Record Time Use for Outpatient Encounters

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment

Association of Adverse Effects of Medical Treatment With Mortality in the United States

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