Implementation or replacement of electronic health records (EHRs) may be disruptive, inconvenient and confusing. It may slow down clinicians and even cause some minor mistakes. But it doesn’t appear to cause additional deaths, adverse events or hospital readmissions, a new study suggests.
“Despite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short-term inpatient mortality, adverse safety events or readmissions in the Medicare population across 17 U.S. hospitals,” said the study, which appeared Thursday in the BMJ.
The research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital examined readmission, patient mortality and rates of adverse patient safety events in Medicare inpatients at 17 hospitals that implemented or replaced EHRs in a big bang-style rollout in 2011 and 2012.
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“We thought that we would see a dramatic spike,” said lead author Dr. Michael Barnett, assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health and a primary care physician at the Brigham.
But that wasn’t the case, a fact that should reassure hospitals and physicians who are considering or planning the implementation of EHRs.
According to the study:
We focused on hospitals that transitioned all inpatient care to a new EHR system in a single day, often referred to as the “go live” date, which offers a quasi-experiment of how quality and safety of inpatient care are affected after transition. We hypothesized that EHR implementation would lead to a short term increase in mortality, readmissions and adverse safety events.
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The results stand in contrast to the natural hits that patient safety takes from time to time.
“There’s a well-documented ‘weekend effect’ and ‘July effect'” on patient safety,” Barnett said.
In other words, more errors happen when hospitals reduce staff on weekends and in July, when new classes of residents typically start. Barnett said that he and his Boston colleagues expected vendor changes to be at least as difficult for hospitals to manage.
Surprisingly, there was not a significant difference on those three metrics in the 90 days before and after the EHR go-live, according to their analysis of Medicare data at those hospitals.
The study said:
We hypothesized that implementation of electronic health records (EHRs) would have a negative association with short-term patient outcomes owing to disruptions in clinical workflow. Contrary to that hypothesis, we found that before and after a discrete “go live” date for EHR implementation across 17 hospitals, there was no evidence of a significant or consistent negative association between EHR implementation and short term mortality, readmissions, or adverse events.
All this is good news for hospitals contemplating a move to EHRs or changing them.
“It looks like there’s no reason to fear that EHRs are damaging high-level patient safety,” Barnett said. “It seems like hospitals and physicians are rather resilient” during the transition.
