Abstract
A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital’s electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012–2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959–0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915–0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider’s efforts to achieve desired quality outcomes and efficiency in Western European hospitals.
Highlights
Implementations of potentially transformative eHealth technologies throughout the world frequently have a significant impact on national health expenditures
One of these methods is the so-called Electronic Medical Record Adoption Model (EMRAM) scoring approach developed by Healthcare Information and Management Systems Society (HIMSS) Analytics [8]
A significant effect is found between patients in the EMRAM low group and the Length of Stay (LOS) in the EMRAM high hospital group when corrected for the case mix, year of operation and type of surgery
Summary
Implementations of potentially transformative eHealth technologies throughout the world frequently have a significant impact on national health expenditures Such large-scale efforts and investments have been justified on the grounds that the EMR, picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerized provider (or physician) order entry systems (CPOE), and computerized decision support systems (CDSS) are supposed to help to address the problems of 84 Page 2 of 7. At least 150 questions per hospital are included about demographics, software functionalities, processes, integration standards, usage in percentage by physician and nurses, depending on the available software in the hospital Previous studies on this model in the Netherlands show that EMRAM stage 3, the first stage in which clinical functionalities (nursing) become available, presents as the first notable challenge to Dutch hospitals; 37.5% of the hospitals in this study have yet to satisfy the requirements of this stage. The basic and more advanced clinical capabilities should help to increase the quality, safety and efficiency of the treatment of patients in the hospital [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
