Basic Electronic Health Record Research Articles

Leveraging Electronic Health Records to Predict the Risk of Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation.

The objective of this study is to assess the electronic health records (EHRs), which are potential risk factors for acute kidney injury (AKI) after allogenic hematopoietic cell transplantation (allo-HCT), and to propose a basic dataset and score for the calculation of HCT-acute kidney injury risk (HCT-AKIR). We undertook a retrospective analysis of the EHRs of 312 patients. Pre- and post-transplant factors were assessed, recognizing the following structured entries: laboratory data, encounters, medication, imaging studies, diagnoses, and procedures. Composite variables were used to create patient groups by combining two or more multivariate significant risk factors for AKI. The EHRs dataset and HCT-AKIR score were created based on the multivariate analysis of the composite variables. A multivariate analysis showed that previous CKD and once-impaired pre-transplant kidney function, sepsis, imaging procedures with contrast media, and cumulative length of intensive care unit stay after transplantation were significant risk factors. A new unit-weighted composite score based on the combination of significant risk factors contained in common EHR resources was proposed. Using our novel HCT-AKIR score calculated from the basic EHR dataset could be an easy way to increase awareness of post-transplant AKI and provide risk stratification.

Electronic Health Record Adoption in Oral and Dental Health Centres in Turkey

The digitalisation studies in public hospitals in Turkey started with the Health Transformation Program in 2003. The Ministry of Health has been measuring the dissemination of meaningful usage and adoption of electronic health record (EHR) using Electronic Medical Record Adoption Model (EMRAM) and Outpatient Electronic Medical Record Adoption Model (O-EMRAM). Using a comprehensive survey, our study intends to measure the stage of EHR adoption in oral and dental health centres (ODHCs) providing primary healthcare services in Turkey. The results obtained were classified by basic and comprehensive EHR functions and benchmarked against the studies addressing EHR adoption in primary healthcare institutions of other countries. In 2021, 167 ODHCs/oral and dental health hospitals (ODHHs) actively operating in Turkey completed the O-EMRAM survey. The data obtained from the survey results were analysed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. It is observed that 59 (40.7%) of ODHCs/ODHHs have comprehensive EHR functions, while the remaining 86 (59.3%) have basic EHR functions. Under these circumstances, it can be stated that all ODHCs/ODHHs in Turkey use at least basic EHR functions. All ODHCs/ODHHs in Turkey have at least basic EHR functions. The integration of e-prescription, electronic authorisation system and e-Pulse used throughout Turkey and Health Information Management System Society (HIMSS) used in ODHCs/ODHHs can be listed as one of the decisive factors in this result. ODHCs/ODHHs still have a long way to go in adopting EHR, but the current circumstances are also promising. It is considered that this study will serve as a baseline for future measurements and produce a notable result for decision-makers.

Pre-pandemic assessment: a decade of progress in electronic health record adoption among U.S. hospitals.

As the COVID-19 pandemic loomed, the adoption of electronic health records (EHRs) in US hospitals became a pivotal concern. This study provides a pre-pandemic assessment, highlighting a decade of progress in EHR adoption from 2009 to 2019, with the last available survey conducted from January to June of 2020. It delves into the current EHR adoption rates, variations across different hospital categories, the influence of major vendors, and the challenges in implementing these systems. The study found that basic EHR adoption surged from 6.6% to 81.2%, while comprehensive systems increased from 3.6% to 63.2%. Despite this growth, the findings point to enduring disparities among hospitals, a concentrated market share by 6 vendors (90%), and significant concerns regarding maintenance costs. These insights provide an invaluable snapshot of the state of EHR adoption at the brink of the pandemic, serving as a benchmark to assess hospitals' readiness to utilize digital infrastructure in health care. The conclusions underscore the necessity for strategic policy interventions to encourage a competitive landscape and guarantee equitable access, ultimately strengthening the health care system's responsiveness to global health crises such as COVID-19.

Basic electronic health record (EHR) adoption in **Türkiye is nearly complete but challenges persist

BackgroundThe digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals’ electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021.MethodsIn 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured.ResultsWe found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%).ConclusionsAlthough there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye.

The Influence of Electronic Health Records on Nursing Practice within Hospital Settings

Usability issues with electronic health records (EHRs) represent a growing threat to the health of nurses and patients, despite the fact that few studies have examined these correlations in depth. The purpose of this study was to investigate how the use of electronic health records has affected nursing practice in hospital settings. EHR adoption and care quality have yet to be extensively studied. The American Hospital Association (AHA) data, state patient discharges, and a survey of nurses were all used to conduct cross-sectional studies. The sample includes 1 281 848 surgical patients, 12 004 nurses, and 343 hospitals. Logistic regression models were used for uncontrolled, randomized studies examining the correlation between EHR usability and outcomes. Using logistic regression models, we analyzed the relationship between nurse-assessed quality of care outcomes and the use of even the most fundamental electronic health record systems. Nurses who worked in facilities equipped with even the most basic EHRs reported significantly fewer incidences than their colleagues at hospitals without EHRs; they had worse results in patient security and other quality measures. Implementing even a minimal EHR could improve the quality of nursing care, facilitate more effective care coordination, and boost patient safety

Machine Learning With Electronic Health Record Data Outperforms a Risk Assessment Prediction Tool in Predicting Discharge Disposition After Total Joint Arthroplasty.

The Risk Assessment Prediction Tool (RAPT) predicts discharge disposition after total joint arthroplasty with only 75% accuracy. The goal of this study was to evaluate whether higher accuracy can be achieved with basic electronic health record (EHR) data combined with machine learning (ML) algorithms. Three ML analysis models were developed: model 1 (M1) evaluated the accuracy of predicted discharge disposition in concordance with the RAPT; model 2 (M2) used the RAPT questionnaire to develop an ML algorithm to predict the likelihood of discharge to home vs facility; and model 3 (M3) was developed with non-RAPT data (age, surgeon, and discharge preference) with the same ML training process as M2. Evaluation metrics included accuracy for home discharge (HD), positive predictive value for HD (PPV-HD), negative predictive value for HD (NPV-HD), sensitivity, specificity, and area under the receiver operating curve (AUROC). A total of 1405 patients were included. With M1, the overall accuracy for HD was 83.5%, PPVHD was 92.1%, NPV-HD was 45%, sensitivity was 0.88, and specificity was 0.56. With M2, the overall accuracy for HD decreased to 82.8%, PPV-HD was 91.7%, NPV-HD was 43.1%, sensitivity was 0.87, specificity was 0.53, and mean AUROC was 0.87±0.03. With M3, overall accuracy for HD increased to 90.3%, PPV-HD was 95.2%, NPV-HD was 68.6%, sensitivity was 0.93, specificity was 0.76, and AUROC was 0.91±0.02. The use of basic EHR data combined with ML can exceed the accuracy of the RAPT. Applying big data on an individual level for this purpose may allow for safer and more appropriate discharge planning. [Orthopedics. 2022;45(4):e211-e215.].

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care.

Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.

A Policy and Practice Review of Consumer Protections and Their Application to Hospital-Sourced Data Aggregation and Analytics by Third-Party Companies.

The Office of the National Coordinator for Health Information Technology estimates that 96% of all U.S. hospitals use a basic electronic health record, but only 62% are able to exchange health information with outside providers. Barriers to information exchange across EHR systems challenge data aggregation and analysis that hospitals need to evaluate healthcare quality and safety. A growing number of hospital systems are partnering with third-party companies to provide these services. In exchange, companies reserve the rights to sell the aggregated data and analyses produced therefrom, often without the knowledge of patients from whom the data were sourced. Such partnerships fall in a regulatory grey area and raise new ethical questions about whether health, consumer, or health and consumer privacy protections apply. The current opinion probes this question in the context of consumer privacy reform in California. It analyzes protections for health information recently expanded under the California Consumer Privacy Act (“CA Privacy Act”) in 2020 and compares them to protections outlined in the Health Information Portability and Accountability Act (“Federal Privacy Rule”). Four perspectives are considered in this ethical analysis: 1) standards of data deidentification; 2) rights of patients and consumers in relation to their health information; 3) entities covered by the CA Privacy Act; 4) scope and complementarity of federal and state regulations. The opinion concludes that the CCPA is limited in its application when health information is processed by a third-party data aggregation company that is contractually designated as a business associate; when health information is deidentified; and when hospital data are sourced from publicly owned and operated hospitals. Lastly, the opinion offers practical recommendations for facilitating parity between state and federal health data privacy laws and for how a more equitable distribution of informational risks and benefits from the sale of aggregated hospital data could be fostered and presents ways both for-profit and nonprofit hospitals can sustain patient trust when negotiating partnerships with third-party data aggregation companies.

"I didn't know you could do that": A Pilot Assessment of EHR Optimization Training.

BackgroundInformatics tools within electronic health records (EHRs)—for example, data rosters and clinical reminders—can help disseminate care guidelines into clinical practice. Such tools’ adoption varies widely, however, possibly because many primary care providers receive minimal training in even basic EHR functions.ObjectivesThis mixed-methods evaluation of a pilot training program sought to identify factors to consider when providing EHR use optimization training in community health centers (CHCs) as a step toward supporting CHC providers’ adoption of EHR tools.MethodsIn spring 2018, we offered 10 CHCs a 2-day, 16-hour training in EHR use optimization, provided by clinician trainers, and customized to each CHC’s needs. We surveyed trainees pre- and immediately post-training and again 3 months later. We conducted post-training interviews with selected clinic staff, and conducted a focus group with the trainers, to assess satisfaction with the training, and perceptions of how it impacted subsequent EHR use.ResultsSix CHCs accepted and received the training; 122 clinic staff members registered to attend, and most who completed the post-training survey reported high satisfaction. Three months post-training, 80% of survey respondents said the training had changed their daily EHR use somewhat or significantly.ConclusionFactors to consider when planning EHR use optimization training in CHCs include: CHCs may face barriers to taking part in such training; it may be necessary to customize training to a given clinic’s needs and to different trainees’ clinic roles; identifying trainees’ skill level a priori would help but is challenging; in-person training may be preferable; and inclusion of a practice coach may be helpful. Additional research is needed to identify how to provide such training most effectively.

Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes

BackgroundNation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size.MethodsEMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated.ResultsWe found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals.ConclusionMeasuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.

Progress and Challenges with Connecting Hospitals with the Public Health System

Improving the health information technology (HIT) infrastructure of the public health system is critical for public health activities and population health management. To strengthen the public health HIT infrastructure, CMS included specific public health reporting capabilities in the Meaningful Use (MU) criteria that comprised the Electronic Health Record (EHR) incentive program for hospitals, now called the Promoting Interoperability (PI) program.Evidence suggests that these incentives have improved hospitals’ public health reporting capabilities, but recent data show that only 60% of hospitals have achieved MU standards, suggesting that barriers remain for electronic integration of hospitals with public health agencies. While progress is promising and may be indicative of improvements in electronic data exchange capabilities, the specific issues that hospitals continue to face are unclear and there remains limited understanding of approaches that may improve hospital public health reporting capabilities.This study uses cross‐sectional data from the 2017 American Hospital Association (AHA) Annual Survey and Information Technology (AHAIT) supplement, which reports the challenges hospitals face in submitting data to public health agencies. Four nonmutually exclusive options included data standards issues, technical capacity issues, uncertainty of who to send data to, and an open‐ended option. Open‐ended responses were qualitatively coded by type of challenge (ie, technology, organization, or environment); responsible/affected party (ie, hospital, public health agency, vendor, or multiple); and the specific issue described. Multivariate logistic regression was used to identify characteristics of hospitals associated with experiencing any challenge.Acute‐care, nonfederal hospitals responding to both the 2017 AHA and AHAIT supplemental surveys.Among 2,794 hospitals included, 1,713 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Of hospitals experiencing challenges, the vast majority reported organizational issues (85% or 1,458) at public health agencies (84% or 1,226), specifically the technical capacity of public health agencies. Hospital system members (adjusted odds ratio (AOR) 0.80; 95% Confidence Interval (CI) 0.65‐0.98) were less likely to experience challenges, whereas for‐profit hospitals (AOR 1.47; 95% CI 1.07‐2.03), being in the West (AOR 1.72; 95% CI 1.28‐2.30), possessing basic (AOR 1.56; 95% CI 1.06‐2.31) or comprehensive (AOR 1.57; 95% CI 1.06‐2.31) EHRs, and participating in an HIE (AOR 1.87; 95% CI 1.58‐2.22) were associated with increased likelihood of experiencing challenges.Challenges remain in facilitating data exchange between hospitals and public health agencies. Hospitals with more advanced EHRs and HIE were more likely to experience challenges. These hospitals may have technological capabilities that exceed those of public health agencies. Hospitals and public health agencies may also be in competition for a technically trained workforce, and data suggest that both may be experiencing shortages of staff with essential expertise.Efforts to alleviate barriers to hospital reporting of health data to public health agencies should target technological, organizational, and environmental issues. Responses include improvements in the data standards that facilitate exchange; funding for public health agencies to improve their technological capabilities, workforce training programs, and clarifications for PI policy specifications and reporting.

The Doctor Will See You Elsewhere: Enterprise IS and the Changing Control of Firm Activities

In this work, we examine how the adoption of enterprise information systems affects the ability of high agency organizational actors to control the activities performed by firms, including both what those activities are and where they are done. While extant research highlights the ability of managers to more carefully manipulate the activities performed by the firm when enterprise IT is adopted, work has yet to examine whether high agency subordinates will use such technology to appropriate rents. Empirically, we investigate whether surgeons reallocate patients to ambulatory care settings for treatment after the adoption of electronic health records (EHR). Findings suggest that while the adoption of basic EHR technology has limited effect, the adoption of advanced EHRs dramatically increases the number of patients treated in an ambulatory care setting. Interestingly, these relationships are strongly moderated by both the financial incentives of the physician and the profit motives of the hospital. Practical and theoretical implications are discussed within.

Reconsidering hospital EHR adoption at the dawn of HITECH: implications of the reported 9% adoption of a "basic" EHR.

ObjectiveIn 2009, a prominent national report stated that 9% of US hospitals had adopted a “basic” electronic health record (EHR) system. This statistic was widely cited and became a memetic anchor point for EHR adoption at the dawn of HITECH. However, its calculation relies on specific treatment of the data; alternative approaches may have led to a different sense of US hospitals’ EHR adoption and different subsequent public policy.Materials and MethodsWe reanalyzed the 2008 American Heart Association Information Technology supplement and complementary sources to produce a range of estimates of EHR adoption. Estimates included the mean and median number of EHR functionalities adopted, figures derived from an item response theory-based approach, and alternative estimates from the published literature. We then plotted an alternative definition of national progress toward hospital EHR adoption from 2008 to 2018.ResultsBy 2008, 73% of hospitals had begun the transition to an EHR, and the majority of hospitals had adopted at least 6 of the 10 functionalities of a basic system. In the aggregate, national progress toward basic EHR adoption was 58% complete, and, when accounting for measurement error, we estimate that 30% of hospitals may have adopted a basic EHR.DiscussionThe approach used to develop the 9% figure resulted in an estimate at the extreme lower bound of what could be derived from the available data and likely did not reflect hospitals’ overall progress in EHR adoption.ConclusionThe memetic 9% figure shaped nationwide thinking and policy making about EHR adoption; alternative representations of the data may have led to different policy.

Progress in using the electronic health record to improve primary care.

The seminal work in the 1970s by Geoffrey Rose on population-based strategies for prevention1 and Julian Tudor Hart on evidence-based anticipatory care2,3 had a profound influence on primary care and were actively supported by the Royal College of General Practitioners. In 1985 in the East London borough of Tower Hamlets, five GP practices collaborated as the Healthy Eastenders Project to support a basic electronic health record (EHR) system, employing nurses for preventive activities and providing comparative audits of their care. By 1992, with the first wave of general practice computerisation, a single EHR system, Egton Medical Information Systems (EMIS), was deployed across all practices in Tower Hamlets with the neighbouring boroughs of City and Hackney and Newham following closely. The Clinical Effectiveness Group (CEG) began to form a supportive network for implementing and evaluating work on preventive care across the locality.4 The early system required ‘floppy disks’ to extract data using Morbidity Information Query and Export Syntax (MIQUEST) with manual transport, usually by bicycle, to the CEG office to collate information from each practice. Although cumbersome, the results were transformative, and for the first time practices could see their own performance and share comparable information with their peers.4–6 In the early days, the theoretical framework used by the CEG team to translate evidence-based innovation into routine clinical practice was necessarily pragmatic. With increasing experience, two complementary strategies framed the process of change. The first included elements of change management described by Kotter.7 These included: building the case for change, forming a coalition that includes both clinicians and managers, empowering others to act on the programme by the provision of education, comparative performance data, and quality improvement tools, creating early wins for the programme, and consolidating the new approach into work-as-usual to …

The Doctor Will See You Elsewhere: Enterprise Information Systems and the Changing Control of Firm Activities

In this work, we examine how the adoption of enterprise information systems affects the ability of high agency organizational actors to control the activities performed by firms, including both what those activities are and where they are done. While extant research highlights the ability of managers to more carefully manipulate the activities performed by the firm when enterprise IT is adopted, work has yet to examine whether high agency subordinates will use such technology to appropriate rents. Empirically, we investigate whether surgeons reallocate patients to ambulatory care settings for treatment after the adoption of electronic health records (EHR). Findings suggest that while the adoption of basic EHR technology has limited effect, the adoption of advanced EHRs dramatically increases the number of patients treated in an ambulatory care setting. Interestingly, these relationships are strongly moderated by both the financial incentives of the physician and the profit motives of the hospital. Practical and theoretical implications are discussed within.

Trends in Use of Electronic Health Records in Pediatric Office Settings

To determine the prevalence and functionalities of electronic health records (EHRs) and pediatricians' perceptions of EHRs. An 8-page self-administered questionnaire sent to 1619 randomly selected nonretired US American Academy of Pediatrics members in 2016 was completed by 709 (43.8%). Responses were compared with surveys in 2009 and 2012. The percent of pediatricians who were using EHRs increased from 58% in 2009 and 79% in 2012 to 94% in 2016. Those with fully functional EHRs, including pediatric functionality, more than doubled from 8.2% in 2012 to 16.9% in 2016 (P = .01). Fully functional EHRs lacking pediatric functionality increased slightly from 7.8% to 11.1% (P = .3), and the percentage of pediatricians with basic EHRs remained stable (30.4% to 31.0%; P < .3). The percentage of pediatricians who lacked basic EHR functionality or who reported no EHR decreased (from 53.6% to 41.0%; P < .001). On average, pediatricians spent 3.4 hours per day documenting care. Although the adoption of EHRs has increased, >80% of pediatricians are working with EHRs that lack optimal functionality and 41% of pediatricians are not using EHRs with even basic functionality. EHRs lacking pediatric functionality impact the health of children through increased medical errors, missed diagnoses, lack of adherence to guidelines, and reduced availability of child-specific information. The pediatric certification outlined in the 21st Century Cures Act may result in improved EHR products for pediatricians.

Environmental market factors associated with electronic health record adoption among cancer hospitals.

Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care. The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals. Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited. In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals. A greater understanding of the environment's relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities' respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.

Resource-based view on safety culture's influence on hospital performance: The moderating role of electronic health record implementation.

Patient safety and safety culture have received increasing attention from agencies such as the Agency of Healthcare Research and Quality and the Institute of Medicine. Safety culture refers to the fundamental values, attitudes, and perceptions that provide a unique source of competitive advantage to improve performance. This study contributes to the literature and expands understanding of safety culture and hospital performance outcomes when considering electronic health record (EHR) usage. Based on the resource-based view of the firm, this study examined the association between safety culture and hospital quality and financial performance in the presence of EHR. Data consist of the 2016 Hospital Survey on Patient Safety, Hospital Compare, American Hospital Association's annual survey, and the American Hospital Association's Information Technology supplement. Our final analytic sample consisted of 154 hospitals. We used a two-part nested regression model approach. Safety culture has a direct positive relationship with financial performance (operating margin). Furthermore, having basic EHR as compared to not having EHR further enhances this positive relationship. On the other hand, safety culture does not have a direct association with quality performance (readmissions) in most cases. However, safety culture coupled with basic EHR functionalities, compared to not having EHR, is associated with lower readmissions. Hospitals should strive to improve patient safety culture as part of their strategic plan for quality improvement. In addition, hospital managers should consider implementing EHR as a resource that can support safety culture's effect on outcomes such as financial and quality performance indicators. Future studies can examine the differences between basic and advanced EHR presence in relation to safety culture.

Overcoming Barriers to Implementing Electronic Health Records in Rural Primary Care Clinics

Medicare-eligible physicians at primary care practices (PCP) that did not implement an electronic health record (EHR) system by the end of 2015 face stiff penalties. One year prior to the 2015 deadline, approximately half of all primary clinics have not implemented a basic EHR system. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants’ experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs systems as manadated by federal legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants including (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of change management at rural medical practices. This study may provide rural primary care physicians and administrators with strategies to promote the adoption of EHRs, provide cost efficient business services, and improve change management plans.