Study finds advanced EHRs can reduce adverse events

Patients with fully electronic health records experienced fewer adverse events such as hospital-acquired infections, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the Journal of Patient Safety.

Fully electronic EHRs have "physician notes, nursing assessments, problem lists, medication lists, discharge summaries and provider orders electronically generated," according to researchers.

Using 2012 and 2013 Medicare Patient Safety Monitoring System data, researchers analyzed outcomes for cardiovascular, pneumonia and surgery patients—specifically, occurrence rates of 21 adverse events in four clinical domains: hospital-acquired infections, adverse drug events, general events (e.g., falls or pressure ulcers) and post-procedural events.

"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," Amy Helwig, MD, deputy director of AHRQ's Center for Quality Improvement and Patient Safety, and Edwin Lomotan, MD, medical officer and chief of clinical informatics at AHRQ's Center for Evidence and Practice Improvement, wrote in a blog post.

Of more than 45,000 patients at risk for nearly 350,000 adverse events in the study sample, 13 percent were exposed to fully electronic health records.

The occurrence rate of adverse events was 2.3 percent, or 7,820 adverse events, among all patients included in the study. Patients with EHRs, meanwhile, had 17 to 30 percent lower odds of experiencing an adverse event.

Helwig and Lomotan said health IT has shown patient safety gains, but little research exists to prove it. Most studies look at one healthcare provider at a time.

"A question that remains unanswered is the impact of fully installed electronic health records systems used in multiple organizations," the authors wrote. "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?"

The findings suggest that hospitals with an advanced EHR can offer more coordinated care from admission to discharge to reduce the risk of patient harm.

However, adverse event odds varied by medical condition and type of 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."