Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

Abstract

A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital’s electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012–2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959–0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915–0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider’s efforts to achieve desired quality outcomes and efficiency in Western European hospitals.

Prediction of perioperative transfusions using an artificial neural network

“…Prior research has shown that clinical decision support systems like ANNs may be connected and embedded with EMR systems [89]. Because of the documented improvements in clinical decision making when clinicians utilize EMR systems [90], integrating the ANN transfusion prediction decision support system with an EMR or surgical planning system would facilitate access by integrating the ANN transfusion prediction decision support tool into their workflow, which would further improve blood bank planning and surgical and post-operative preparation [91] and consequently improve patient outcomes. The ANN would be able to alert surgeons to possible unexpected complications that would lead to a transfusion even if none were anticipated and could also be used to confirm the necessity of surgeon blood orders.…”

Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

“…A relationship between response rates and outcomes could be informative, for example, when response rates are considered a proxy for certain structures or processes of care organization that may influence the outcome (assuming adequate adjustment for case mix). For example, digitization in hospitals can ease recruitment and may also improve outcomes 21 …”

“…For example, digitization in hospitals can ease recruitment and may also improve outcomes. 21 Hospital comparison research usually aims to explore whether there is an association between the treating hospital and the patients' outcome. Herein, factors that affect both the outcome and the hospital in which the patient is treated should be taken into account, that is, confounding factors ( Figure B2).…”

Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value

“…Nevertheless, informed patient consent and patient anamnesis obtained during patient-physician interactions are still mainly archived in hard-copy form and remain unavailable for further use. Digitization has the potential to increase the efficiency of healthcare systems [1]: improved software technology and mobile devices, meanwhile, can help to spread this technology into hospitals [2][3][4][5]. Particularly in radiology departments, high levels of digitization are already common and necessary; however, PA and patients' current clinical problems are often incomplete, outdated, or inaccessible [6].…”