The Association between eHealth Capabilities and the Quality and Safety of Health Care in the Netherlands: Comparison of HIMSS Analytics EMRAM data with Elsevier's 'The Best Hospitals' data.

Lorren Pettit,Rube Van Poelgeest,Jan-Peter Heida,Rob J De Leeuw,Guus Schrijvers

doi:10.1007/s10916-015-0274-7

Abstract

ObjectiveTo test the hypothesis that advanced electronic medical record (EMR) capabilities are associated with better quality and safety of hospital care.Methods and FindingsWe used data from the HIMSS Analytics EMR Adoption Model (EMRAMSM) to measure the adoption and use of information technology in Dutch hospitals. To measure the quality and safety of healthcare in Dutch Hospitals we used select data from the publicly available basic set and the safety set of the Health Care Inspectorate (IGZ) and the Dutch Health Care Transparency Program ‘Zichtbare Zorg’ (ZIZO) program. The quality and safety measures selected reflect the measures used to score Dutch hospitals as presented in Elsevier’s annual ‘The Best Hospitals’ publication. The scores of this publication are based upon 542 of the 1516 available indicators from this basic set and safety set. Almost all indicators from the hospital-wide indicator sets are included in the selection, as are a large portion of indicators for acute care delivered by all hospitals. Of the 84 non-academic hospitals in the Netherlands, 67 (80 %) were included in this study.ResultsThere is no statistically significant association found between a hospital’s EMRAM score and their overall quality/safety performance in the Elsevier hospital scoring model.ConclusionThere is no evidence found to support the research hypothesis at this point in time. This outcome maybe the result of a multiplicity of factors to include the (limited) use of the methodologies used in this study, the fact that no fully digitalized hospital (EMRAM stage 7) is yet present in the NL, and/or the organizational competency of the NL hospitals in fully leveraging the EMR to facilitate patient care. Further research is needed to explore these findings.

Highlights

Implementations of potentially transformative information technologies are currently underway internationally, often with significant impact on national expenditure [1, 2]. Such large-scale efforts and expenditures have been justified on the grounds that electronic medical record (EMR), picture archiving and communication systems (PACS), electronic prescribing and associated computerized provider order entry systems (CPOE), and computerized decision support systems (CDSS) are supposed to help to address the problems of variable quality and safety in modern health care [3]
The hypothesis of this study, that there is a positive association between advanced electronic medical record (EMR) capabilities and quality and safety of hospital care in The Netherlands was not supported at this point in time by the findings of this study
Hospitals could qualify as a stage 4 hospital if the required functionalities and facilities are implemented in only one patient care service area in the hospital even though other parts of the hospital reflect the capabilities of lower Electronic Medical Record Adoption Model (EMRAM) stages

Summary

Introduction

Implementations of potentially transformative information technologies are currently underway internationally, often with significant impact on national expenditure [1, 2]. Such large-scale efforts and expenditures have been justified on the grounds that 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 variable quality and safety in modern health care [3]. This paper has the objective to contribute to the scientific discourse on the relationship between the digitalization of hospital care and quality and safety of such care by exploring the experience in one European country with fairly advanced EMR capabilities: The Netherlands. The hypothesis to be tested is: advanced electronic medical record (EMR) capabilities are positively associated with quality and safety of hospital care

Methods

Results

Discussion

Conclusion