EHRs Associated with Lower Hospital Mortality

Researchers at the University of Michigan (U-M; Ann Arbor, USA), the Harvard Global Health Institute (Cambridge, MA, USA), and other institutions conducted a study that analyzed data sets from 5,992 US hospitals in order to examine how adoption of EHR might be associated with 30-day mortality rates. The data provided EHR function adoption dates, hospital characteristics, and the hospital's mortality performance.

The researchers assessed mortality rates as hospitals adopted each of 10 basic EHR functions. Mortality rates only included 15 common conditions and were combined into an overall risk rate adjusted for sex, age, and comorbidities. Hospital characteristics included location (urban/suburban versus rural), size, teaching status, and safety net status. Hospitals initially adopted EHR systems with an average 5.7 basic EHR functions, with an average 30-day mortality rate of 13.46 per 100 admissions. Death rates were initially higher at baseline by 0.11% points per EHR function added.

Subsequently, mortality rates dropped by an average 0.09% points per year per function. Each added function after that was associated with a drop in mortality rates of 0.21% points. EHR adoption was also linked to lower mortality rates overall over time: Hospitals that adopted EHRs had 0.67 fewer deaths per 100 admissions per year compared with non-adopting hospitals. Further analysis suggested mortality reduction from adoption was significantly greater for small and nonteaching hospitals. The study was published on June 9, 2018, in Health Affairs.

“The relationship between EHR adoption and performance is not as simple and straightforward as, 'does it work’? Much of the performance improvement we observed in our study occurred either with the maturation effect of baseline functions or with the addition of functions each year,” concluded lead author doctoral candidate Sunny Lin, MSc, of U-M. “Large and teaching hospitals have the resources to continuously engage in quality improvement, both before and after EHR adoption, so the EHR itself might not have resulted in similarly substantial gains in performance.”

The 2009 American Reinvestment & Recovery Act (ARRA) included many measures to modernize infrastructure, one of which is the Health Information Technology for Economic and Clinical Health (HITECH) Act. ARRA set aside nearly USD 20 billion in incentives for hospitals and physicians who adopt qualified, certified EHRs with the ability to exchange information with other sources, which is defined conceptually as meaningful use.

Related Links:
University of Michigan
Harvard Global Health Institute