Suzi Birz, principal, HiQ Analytics, LLC
Recent events have brought much attention to electronic health records (EHRs) and their impact on the health care system. President Obama has called for “EHRs for Americans by 2014,” and the American Recovery and Reinvestment Act of 2009 includes incentives for providers demonstrating “meaningful use” of EHRs.
Researchers in Texas recently published the results of a study to examine the impact on clinical and financial outcomes of clinical information technologies.
“We examined the association between a hospital’s automation and inpatient mortality, complications, costs, and length of stay among patients with four medical conditions in a diverse group of Texas hospitals,” stated Ruben Amarasingham, MD, MBA at Parkland Health and Hospital System in Dallas, Texas.
The research associated a 15 percent decrease in fatal hospitalizations with each 10-point increase of notes and records as measured with their assessment tool, indicating that greater automation is associated with reduced rates of inpatient mortality.
With respect to cost, higher scores on use of the technology for test results, order entry and decision support were overwhelmingly associated with lower costs.
Also, increased use was associated with the reduction in the odds of death for myocardial infarction and coronary artery bypass graft surgery.
“The study accounted for three important aspects of technology adoption,” explained Amarasingham. “Firstly, did the physician know the technology was available? Did the physician know how to use the technology? And, did the physician choose to use the technology? Investment in the technology alone is insufficient; active involvement of the clinicians and many areas of administration is required.”
During design and implementation of clinical systems, important decisions are made daily related to alerts and care pathways among other areas. “Ideas must be challenged and difficulties anticipated,” Amarasingham noted.
“Some processes should not be automated,” he said “In some cases, the original workflow works just fine.”
“It’s not as important that the people involved be technical experts, but that they relate to their peers and anticipate the needs of those that might struggle with the new systems,” he added.
Patient care and the coordination of that care are changing. More professionals than ever are involved in the care process, including physical therapists, nurses, pharmacists, social workers and consulting physicians. “The EHR can facilitate the coordination of information transfer in this era of fragmented care,” Amarasingham said.
“This study focused on physician use of technology; however the role of nursing is vital,” he noted.
“Nurses are central to the design of any technology implementation used in the nursing workflow. Successful nurse champions are highly respected in the health care setting, have a sense of organizational history and have an understanding of different areas throughout the hospital.”
“Implementing an EHR requires hospital leadership to take the long view,” he cautioned. “The design, implementation and ongoing optimization is expensive in both money and work effort.”
Amarasingham pointed out that the study does not control for a hospital’s culture of safety and continuous improvement. “High functioning systems require a focus on quality, safety and quality improvement.”
“Clinical information technologies hold great promise as a tool to improve hospital medicine,” he concluded. “Embracing information technology is something that we owe our patients and ourselves.”
This study is published in the Archives of Internal Medicine. Dr. Amarasingham can be reached at the Center for Knowledge Translation and Clinical Innovation at Parkland Health and Hospital System.
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