245209 Effect of electronic health record subsystems on hospital-wide risk-adjusted mortality rates of Medicare patients with acute myocardial infarction and congestive heart failure

Monday, October 31, 2011

Peiyin Hung , Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, GA
Laura M. Gaydos, PhD , Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
Edmund R. Becker , Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, GA
Background: The final rule from CMS for the meaningful use of electronic health records (EHR) leaves unanswered basic questions about how the implementation of different EHR subsystems and the sequence of the implementation influences various treatment outcomes. Objectives: To examine the impact of five EHR subsystems on risk-adjusted mortality rates (RSMRs) in patients with AMI or CHF. Methods: 969 non-federal, acute care hospitals in 12 states were extracted from the linked 2008 American Hospital Association EHR Survey and CMS Hospital Compare Database. Adjusting for major hospital characteristics using least squares regression and propensity scores, we analyzed the impact of both EHR adoption and number of adopted EHR subsystems (clinical documentation, test results viewing system, physician order entry, decision support, bar-code system) on the outcomes of AMI and CHF inpatients. Results: Significant variation exists in the implementation of EHR subsystems across U.S. hospitals. The presence of an EHR in a hospital resulted in significant reductions in RSMRs for both AMI and CHF by as much as 0.59%. Adopting an additional subsystem resulted in a reduction in AMI and CHF RSMRs by 0.24% and 0.13%, respectively. However, optimal results were achieved in AMI when hospitals fully adopted at least 3 subsystems; for CHF, results were optimal when a hospital had adopted all 5 subsystems. Conclusions: Adoption of EHR reduces AMI and CHF mortality rates, but their effectiveness is dependent on how many subsystems are adopted. National implementation efforts may benefit from taking into account the sequence of EHR subsystem adoption in hospitals.

Learning Areas:
Administer health education strategies, interventions and programs
Biostatistics, economics
Chronic disease management and prevention
Program planning
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
1. To evaluate whether electronic health record adoption reduces acute myocardial infarction (AMI) or congestive heart failure (CHF) mortality rates 2. To identify the effects of number of electronic health record components on mortality rates of AMI and CHF inpatients

Keywords: Adoption, Health Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I have been doing studies on electronic health records and patient safety for about two years. I understand how health information technology intervention is transforming the U.S. health care realm. I also worked in three medical centers and have been trained on health policy research in the Master of Science in Public Health program of Department of Health Policy and Management, Rollins School of Public Health at Emory University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.