Online Program

Impact of Electronic Health Records on Hospital Acquired Adverse Safety Events: Roles of Physician Cooperation

Wednesday, November 4, 2015 : 1:30 p.m. - 1:50 p.m.

Jaeyong Bae, School of Nursing and Health Studies, Northern Illinois University, Dekalb, IL
Jason Hockenberry, PhD, Health Management & Policy, Emory University, Atlanta, GA
Kimberly J. Rask, MD, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
Edmund R. Becker, PhD, Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, GA

Electronic Health Records (EHRs) potentially reduce the patient safety problems. Empirically, there has been modest evidence that EHR improves patient safety. The potential benefits accruing to an EHR investment are dependent in part on the degree of staff support for, or conversely, resistance against EHR implementation.


We estimate to what extent staff support, as measured by physician resistance, impacts the magnitude of EHR-associated changes in hospital acquired adverse safety events.


We linked patient administrative data from 2010 New York State Inpatient Databases of the Healthcare Cost and Utilization Project to the Information Technology Supplement to the American Hospital Association’s Annual Survey. The primary outcome is hospital acquired adverse safety events, measured by 15 types of patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality based on diagnosis codes. Using present on admission (POA) flags for diagnosis codes, we construct hospital acquired PSI measures. PSIs acquired during hospital stay identify potential hospital adverse patient safety events and complications. The key explanatory variables are interactions between basic EHR adoption and physician resistance. Physician resistance indicates whether hospitals had physician resistance to adopt EHRs. We use multivariable regressions controlled for patient characteristics, patient health status, hospital characteristics, and area characteristics.


Among patients at risk for at least 1 of 15 patient safety events, 1.84% had at least one hospital acquired adverse safety event. Basic EHR adoption was associated with decrease in hospital-acquired adverse safety events by 15.2% (p<.05) at hospitals without physician resistance. On the other hand, at hospitals with physician resistance, basic EHR adoption was associated with increase in hospital-acquired adverse safety events by 23.4% (p<.01).


EHRs reduced hospital acquired adverse safety events when there was no physician resistance. The successful implementation of EHR systems requires favorable organizational characteristics such as physician cooperation to adopt EHRs.

Learning Areas:

Administration, management, leadership
Public health or related research

Learning Objectives:
Evaluate differential impacts of EHRs on hospital-acquired adverse patient safety events, depending on the degree of physician resistance. Discuss how favorable organizational/environmental factors contribute to the effectiveness of EHR use. Design appropriate measures of adverse patient safety events during hospitalization using patient administrative data.

Keyword(s): Quality Improvement, Information Technology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD in Health Services Research and Health Policy and have conducted various health services research projects. Currently, I am an assistant professor of public health in Northern Illinois 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.