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Can Full EHR Adoption Decrease Adverse Patient Safety Events?

Adverse patient safety events are significantly less common in hospitals using a fully electronic EHR system, new AHRQ research suggests.

- Electronic health records haven’t always had a spotless reputation when it comes to patient care, but the Agency for Healthcare Research and Quality (AHRQ) believes that a comprehensive EHR adoption program can, in fact, slash the number of adverse patient safety events that occur in the inpatient setting.

Adverse patient safety events and EHRs

In a new study published this month in the Journal of Patient Safety, AHRQ researchers state that patients treated in facilities with a fully electronic EHR system are between 17 percent and 30 percent less likely than others to experience an adverse patient safety event.

“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,” said Amy Helwig, MD, MS, Deputy Director of the AHRQ Center for Quality Improvement and Patient Safety and Edwin Lomotan, MD, Medical Officer and Chief of Clinical Informatics at the Center for Evidence and Practice Improvement.

For the purposes of the study, a “fully electronic” EHR is one that includes digital physician notes, nursing assessments, problem and medication lists, discharge summaries, and provider orders, Helwig and Lomotan explain. 

These capabilities are often used to coordinate care and reduce the likelihood of adverse events such as infections, pressure ulcers, and medication-related harm.

However, “a question that remains unanswered is the impact of fully installed electronic health records (EHR) systems used in multiple organizations,” Helwig and Lomotan said. “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?”

AHRQ researchers examined data on more than 45,000 patients at 1351 hospitals included in the 2012 and 2013 Medicare Patient Safety Monitoring System (MPSMS).  These patients were adults who were hospitalized for acute cardiovascular disease, pneumonia, or conditions requiring surgery, which put them at higher-than-average risk for an adverse patient safety event.

The actual rate of harm among these patients was 2.3 percent, and just 13 percent of those patients received their care in a fully electronic EHR environment.  The observed reduction in the likelihood of harm varied across patient type and safety category, the study added.

Pneumonia patients in a fully electronic hospital were 25 percent less likely than other patients to experience any sort of general patient safety event, including 35 percent less likely to be involved in an adverse drug event and 34 percent less likely to develop a hospital-acquired infection.

Cardiovascular surgery patients saw a 31 percent reduction in the likelihood of post-procedural events and 21 percent fewer generalized events.  For patients hospitalized for other types of surgery, a fully electronic EHR was associated with a 36 percent decrease in hospital-acquired infections.

“Like all good research, the AHRQ study addresses some questions and raises others,” Helwig and Lomotan acknowledge.

“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.”

And while the study may follow in the footsteps of research from the Pennsylvania Patient Safety Authority and the ONC stating that EHRs can produce positive patient safety gains, the dark side of electronic health records remains a top concern for many stakeholders.

EHRs have been a permanent resident of the ECRI’s annual lists of health IT hazards for several years, and industry discussions about the impact of electronic tools on care coordination, clinician workflow, and patient monitoring have often taken a very negative tone.

The Institute of Medicine (IOM) recently released a report urging the healthcare industry to use their EHRs and other health IT tools more effectively in the fight against adverse patient safety events, reiterating the importance of developing thoughtful, intuitive, and human-centered workflows reinforced through appropriate staff training and education.

“Health IT vendors and the ONC should work together with users to ensure that health IT used in the diagnostic process demonstrates usability, incorporates human factors knowledge, integrates measurement capability, fits well within clinical workflow, provides clinical decision support, and facilitates the timely flow of information among patients and health care professionals involved in the diagnostic process,” the IOM said.

Lawmakers have acted to address these EHR usability concerns by introducing new legislation to the Senate that would overhaul the way electronic health records are tested and certified.  These changes are intended to increase health data interoperability – a foundational competency for care coordination – and make it easier for providers to choose health IT products that will help the industry continue its overall reduction of patient safety 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,” the AHRQ team concludes.  “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.”

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