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Meaningful Use of Electronic Health Record Systems and Process Quality of Care: Evidence from a Panel Data Analysis of U.S. Acute‐Care Hospitals
Author(s) -
Appari Ajit,
Eric Johnson M.,
Anthony Denise L.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2012.01448.x
Subject(s) - quartile , medicine , quality (philosophy) , emergency medicine , health care , quality management , electronic health record , medical emergency , operations management , confidence interval , epistemology , management system , philosophy , economics , economic growth
Objective To estimate the incremental effects of transitions in electronic health record ( EHR ) system capabilities on hospital process quality. Data Source Hospital Compare (process quality), H ealth I nformation and M anagement S ystems S ociety A nalytics ( EHR use), and I npatient P rospective P ayment S ystem (hospital characteristics) for 2006–2010. Study Setting Hospital EHR systems were categorized into five levels (Level_0 to Level_4) based on use of eight clinical applications. Level_3 systems can meet 2011 EHR “meaningful use” objectives. Process quality was measured as composite scores on a 100‐point scale for heart attack, heart failure, pneumonia, and surgical care infection prevention. Statistical analyses were conducted using fixed effects linear panel regression model for all hospitals, hospitals stratified on condition‐specific baseline quality, and for large hospitals. Principal Findings Among all hospitals, implementing Level_3 systems yielded an incremental 0.35–0.49 percentage point increase in quality (over Level_2) across three conditions. Hospitals in bottom quartile of baseline quality increased 1.16–1.61 percentage points across three conditions for reaching Level_3. However, transitioning to Level_4 yielded an incremental decrease of 0.90–1.0 points for three conditions among all hospitals and 0.65–1.78 for bottom quartile hospitals. Conclusions Hospitals transitioning to EHR systems capable of meeting 2011 meaningful use objectives improved process quality, and lower quality hospitals experienced even higher gains. However, hospitals that transitioned to more advanced systems saw quality declines.