Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis.

Bradley Beauvais,Lawrence Fulton,Clemens Scott Kruse,Ramalingam Shanmugam,Matthew Brooks,Zo Ramamonjiarivelo

doi:10.2196/23961

Abstract

BackgroundElectronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear.ObjectiveIn this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance.MethodsThis study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value–Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure.ResultsNone of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; β=−.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%).ConclusionsThe results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.

Highlights

BackgroundIn the first part of the 20th century, health care predominantly revolved around a single health care provider, diagnosing and treating patients within the confines of their office or in the patient’s home, and patient medical histories were recorded on paper
The data for this study were extracted from two primary sources: the Definitive Health Care database and the American Hospital Association (AHA) Annual Survey database for 2018
The distributions of most of the dependent variables were relatively normal; the Hospital Value–Based Purchasing (HVBP) efficiency score was skewed to the right

Summary

Introduction

BackgroundIn the first part of the 20th century, health care predominantly revolved around a single health care provider, diagnosing and treating patients within the confines of their office or in the patient’s home, and patient medical histories were recorded on paper. In 2009, President Barack Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act (ARRA) and originally set aside US $27 billion for an incentive program that encouraged hospitals and providers to adopt EHR systems [7,8] This legislation prompted the adoption of EHRs in 2014 and established time frames for mandated EHR adoption. Conclusions: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery

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