Can Electronic Health Records Prevent Harm to Patients?
By Amy Helwig, M.D., M.S., Deputy Director, AHRQ’s Center for Quality Improvement and Patient Safety
Edwin Lomotan, M.D., Medical Officer and Chief of Clinical Informatics, AHRQ's Center for Evidence and Practice Improvement
Health information technology (HIT) has been shown to improve patient safety, especially with processes and applications that improve clinicians' decisionmaking, documentation, and communication.
But research has often looked at these applications in single institutions. A question that remains unanswered is the impact of fully installed electronic health records (EHR) systems used in multiple organizations. Another big question: can EHRs go beyond improving safety-related processes to actually preventing adverse events, such as potentially deadly hospital-acquired infections, from reaching patients?
A new AHRQ-funded study appearing in the February 6 issue of The Journal of Patient Safety gives us some insight into these questions. It found that cardiovascular, surgery, and pneumonia patients whose complete treatment was captured in a fully electronic EHR were between 17 and 30 percent less likely to experience in-hospital adverse events.
The findings suggest that hospitals with EHRs can provide what advocates have long claimed: better coordinated care from admission to discharge that reduces the risk of harm reaching patients.
In the study, a research team led by AHRQ investigators analyzed patient medical record data from the 2012 and 2013 Medicare Patient Safety Monitoring System (MPSMS). The database includes 21 hospital adverse event measures that are considered to be bellwethers of patient safety. Researchers grouped the measures into four categories: hospital-acquired infections, such as central line-associated bloodstream infections; adverse drug events; general events, such as falls and pressure ulcers; and post-procedural events, such as blood clots.
To assess the role of EHRs in preventing adverse events, the researchers measured to what extent care received by patients in the 1,351 hospitals was captured by a fully electronic EHR. Hospital care was categorized as:
- Fully electronic, in which all physician notes, nursing assessments, problem lists, medication lists, discharge summaries, and provider orders are electronically generated.
- Partially electronic, in which some, but not all, of those components are electronically generated.
- Non-electronic, in which none of these components are present.
Among the patients in the study sample, 347,281 exposures to adverse events occurred. Of these exposures, 7,820 adverse events actually took place, resulting in a 2.25 percent occurrence rate of events for which patients were at risk. Occurrence rates were highest among patients hospitalized for pneumonia and lowest among patients requiring surgery.
Thirteen percent, or 5,876 patients, received care that was captured by a fully electronic EHR. While these patients had lower odds of any adverse event, this association varied by medical condition and type of adverse event.
For example, patients hospitalized for pneumonia and exposed to a fully electronic EHR had 35 percent lower odds of adverse drug events, 34 percent lower odds of hospital-acquired infections, and 25 percent lower odds of general events. Among patients hospitalized for cardiovascular surgery, a fully electronic EHR was associated with 31 percent lower odds of post-procedural events and 21 percent fewer general events. Fully electronic EHRs were associated with a 36 percent lower odds of hospital-acquired infections among patients hospitalized for surgery.
The findings build on the results of a 2014 study of Pennsylvania hospitals that used patient safety data drawn from the Pennsylvania Patient Safety Authority, into which hospitals are required to report patient safety events. Hospitals using advanced EHRs had a 27 percent overall decline in these events, the authors found, fueled by a 30 percent drop in events due to medication errors.
Like all good research, the AHRQ study addresses some questions and raises others.
The findings showed a significant relationship between fully electronic EHRs and adverse drug event rates for patients hospitalized with pneumonia, but not for those with cardiovascular disease or needing surgery. This may be due to the fact that certain high-alert medications, such as opioids, which are often associated with adverse drug events, were not included in the MPSMS measures. Also, the study did not address which safety features of EHRs had been optimized or which applications had the greatest impact on reducing adverse events.
As of today, most hospitals and clinicians have embraced specific EHR applications and we continue to see implementation of more quality and safety features. EHRs can play a key role in preventing adverse events, and as this study suggests, adoption of EHRs can better manage the multiple tasks that prevent adverse events before they occur, keeping patients safer as a result.