Electronic Health Records Associated With Lower Hospital Mortality After Systems Have Time To Mature

Lin, Sunny C.; Jha, Ashish K.; Adler‐Milstein, Julia

doi:10.1377/hlthaff.2017.1658

Cited by 67 publications

(53 citation statements)

References 25 publications

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“…The more experience that clinicians have with EHR systems may be associated with more favorable observations of their effectiveness, 13,16 as well as better patient outcomes. 47 Few rural hospitals were included in our sample which limits conclusions that can be made about EHR use in those hospitals. Recent research suggests a widening divide in adoption of comprehensive EHRs between urban and rural hospitals.…”

Section: Limitationsmentioning

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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Section: Limitationsmentioning

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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“…Over time, implementation of health IT may lead to benefits for patients as demonstrated by the study by Lin et al 4 , which shows positive outcomes (e.g. hospital mortality) associated with health IT after sufficient time and effort has been spent on implementation, maintenance, and improvement of the system.…”

Section: Introductionmentioning

confidence: 99%

Human Factors and Usability for Health Information Technology: Old and New Challenges

2019

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Objectives: Despite national mandates, incentives, and other programs, the design of health information technology (IT) remains problematic and usability problems continue to be reported. This paper reviews recent literature on human factors and usability of health IT, with a specific focus on research aimed at applying human factors methods and principles to improve the actual design of health IT, its use, and associated patient and clinician outcomes. Methods: We reviewed recent literature on human factors and usability problems of health IT and research on human-centered design of health IT for clinicians and patients. Results: Studies continue to show usability problems of health IT experienced by multiple groups of health care professionals (e.g., physicians and nurses) as well as patients. Recent research shows that usability is influenced by both designers (e.g., IT vendors) and implementers in health care organizations, and that the application of human-centered design practices needs to be further improved and extended. We welcome emerging research on the design of health IT for teams as team-based care is increasingly implemented throughout health care. Conclusions: Progress in the application of human factors methods and principles to the design of health IT is occurring, with important information provided on their actual impact on care processes and patient outcomes. Future research should examine the work of health IT designers and implementers, which would help to develop strategies for further embedding human factors engineering in IT design processes.

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“…CPOE systems are embedded within complex sociotechnical environments that require intentional quality improvement efforts to manifest a reduction in adverse drug events and an improvement in patient safety 8. Similarly, recent work has shown that EHR adoption has a positive effect on patient mortality, but only after a period of acclimation and system maturation 12. Other studies have found that CPOE system may actually contribute to medical errors 13…”

Section: Introductionmentioning

confidence: 99%

Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support

Holmgren

Newmark

et al. 2019

BMJ Qual Saf

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BackgroundElectronic health records (EHR) can improve safety via computerised physician order entry with clinical decision support, designed in part to alert providers and prevent potential adverse drug events at entry and before they reach the patient. However, early evidence suggested performance at preventing adverse drug events was mixed.MethodsWe used data from a national, longitudinal sample of 1527 hospitals in the USA from 2009 to 2016 who took a safety performance assessment test using simulated medication orders to test how well their EHR prevented medication errors with potential for patient harm. We calculated the descriptive statistics on performance on the assessment over time, by years of hospital experience with the test and across hospital characteristics. Finally, we used ordinary least squares regression to identify hospital characteristics associated with higher test performance.ResultsThe average hospital EHR system correctly prevented only 54.0% of potential adverse drug events tested on the 44-order safety performance assessment in 2009; this rose to 61.6% in 2016. Hospitals that took the assessment multiple times performed better in subsequent years than those taking the test the first time, from 55.2% in the first year of test experience to 70.3% in the eighth, suggesting efforts to participate in voluntary self-assessment and improvement may be helpful in improving medication safety performance.ConclusionHospital medication order safety performance has improved over time but is far from perfect. The specifics of EHR medication safety implementation and improvement play a key role in realising the benefits of computerising prescribing, as organisations have substantial latitude in terms of what they implement. Intentional quality improvement efforts appear to be a critical part of high safety performance and may indicate the importance of a culture of safety.

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Electronic Health Records Associated With Lower Hospital Mortality After Systems Have Time To Mature

Cited by 67 publications

References 25 publications

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

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

Human Factors and Usability for Health Information Technology: Old and New Challenges

Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support

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