Use Of EHRs Research Articles

Academic Electronic Health Record in Mental Health Clinical: A Quality Review.

Developing competency in the use of EHRs is essential for entry-level professional nurses. Although nursing education has been encouraged to integrate this technology into nursing curriculum, many students still graduate feeling unprepared in this area. As a result, nursing graduates lack the skills necessary to effectively use EHRs, which may have negative consequences for safe patient care. Use of academic EMRs provides students the opportunity to integrate informatics education, develop critical thinking, and incorporate problem-solving skills in the clinical area. An academic EMR was introduced to students in the second semester of a baccalaureate degree nursing program. Students completed documentation on one patient from the mental health clinical rotation. A retrospective chart review was conducted, using a rubric to determine charting efficacy. Data analysis indicated that students struggled with documentation of the mental health assessment, care plan development, and nursing notes. Student documentation was strongest in vital signs and basic information. Students need practice documenting on the critical aspects of nursing care. Utilization of an academic EMR for clinical charting provides an opportunity for students to practice documentation and develop necessary skills for clinical practice.

Electronic health record-based behaviour change interventions aimed at general practitioners in the UK: a mixed methods systematic review using behaviour change theory

ObjectivesElectronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians’ behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice...

The influence of electronic health record use on healthcare providers burnout

BackgroundElectronic health records (EHRs) are critical health information technology tools that ensure accuracy and improved management of patient records. However, the use of EHRs can lead to significant burden and burnout among healthcare providers, potentially affecting the quality of care they deliver. ObjectivesThe purpose of this study is to determine the extent of burnout among healthcare providers who use EHRs, with the specific objectives of assessing the level of EHR-related burnout in Saudi Arabian hospitals and identifying the key EHR-related factors contributing to this burnout. MethodsA descriptive quantitative cross-sectional study was conducted. A valid and reliable questionnaire was distributed to healthcare providers in Saudi Arabian hospitals to measure their burnout levels associated with EHR usage. ResultsThe findings indicate that the use of EHRs contributes to healthcare provider burnout, which may diminish the quality of care provided to patients. Several variables were significantly related to the healthcare providers' personal burnout, i.e., their living area, age, job, and year of experience, although only the healthcare provider's age influences their work-related burnout significantly. On the other hand, working hours per week and number of patients per week significantly influence the healthcare provider's EHR-related burnout. ConclusionThe study suggests that EHR usage is a significant factor in healthcare provider burnout. Addressing this issue requires enhanced training, workload reduction, and prompt resolution of EHR-related problems to improve provider well-being and maintain high-quality patient care.

Using Electronic Health Records to Improve Patient Health Care

Background: EHRs have the potential to improve patient healthcare by providing real-time access to patient information, improving communication between healthcare providers, and reducing medication errors. However, the evidence on the impact of EHRs on clinical outcomes is mixed. Objective: To review the literature on the impact of EHRs on clinical outcomes and to provide recommendations for improving the use of EHRs to improve patient healthcare. Methods: A literature review was conducted to identify studies on the impact of EHRs on clinical outcomes. The search was limited to English-language studies published in peer-reviewed journals. Results: The literature review found that EHRs have the potential to improve clinical outcomes, such as mortality, morbidity, hospital readmission rates, and bed utilization. EHRs can also help to reduce medication errors and improve patient safety. However, the impact of EHRs depends on a number of factors, such as the quality of the EHR system, the way it is implemented, and the training of healthcare providers. Recommendations: For improving the use of EHRs to improve patient healthcare include: Developing high-quality EHR systems that are easy to use and can integrate with other systems, Providing adequate training for healthcare providers on how to use EHRs effectively, Encouraging interoperability between EHR systems from different vendors, Addressing privacy and security concerns, Reducing user resistance to EHRs. Conclusion: EHRs have the potential to improve patient healthcare by providing real-time access to patient information, improving communication between healthcare providers, and reducing medication errors. However, the impact of EHRs depends on a number of factors, such as the quality of the EHR system, the way it is implemented, and the training of healthcare providers. By following the recommendations above, we can make EHRs a more effective tool for improving patient healthcare.

Informatics approaches to improve the quality of dental care.

Despite technological advances, challenges exist in US dental care, including variations in quality of care, access and untreated dental needs. The implementation of learning health systems (LHSs) in dentistry can help to address these challenges. LHSs use robust informatics infrastructure including data and technology to continuously measure and improve the quality and safety of care and can help to reduce costs and improve patient outcomes. The use of EHRs and standardized diagnostic terminologies are highlighted, as they allow for the storage and sharing of patient data, providing a comprehensive view of a patient's medical and dental history, and can be used to identify patterns and trends to improve the delivery of care. The BigMouth Dental Data Repository is an example of an informatic platform that aggregates patient data from multiple institutions and is being used to for scientific inquiry to improve oral health.

A Deep Learning Approach to Estimate the Incidence of Infectious Disease Cases for Routinely Collected Ambulatory Records: The Example of Varicella-Zoster.

The burden of infectious diseases is crucial for both epidemiological surveillance and prompt public health response. A variety of data, including textual sources, can be fruitfully exploited. Dealing with unstructured data necessitates the use of methods for automatic data-driven variable construction and machine learning techniques (MLT) show promising results. In this framework, varicella-zoster virus (VZV) infection was chosen to perform an automatic case identification with MLT. Pedianet, an Italian pediatric primary care database, was used to train a series of models to identify whether a child was diagnosed with VZV infection between 2004 and 2014 in the Veneto region, starting from free text fields. Given the nature of the task, a recurrent neural network (RNN) with bidirectional gated recurrent units (GRUs) was chosen; the same models were then used to predict the children’s status for the following years. A gold standard produced by manual extraction for the same interval was available for comparison. RNN-GRU improved its performance over time, reaching the maximum value of area under the ROC curve (AUC-ROC) of 95.30% at the end of the period. The absolute bias in estimates of VZV infection was below 1.5% in the last five years analyzed. The findings in this study could assist the large-scale use of EHRs for clinical outcome predictive modeling and help establish high-performance systems in other medical domains.

User Perceptions and Use of an Enhanced Electronic Health Record in Rwanda With and Without Clinical Alerts: Cross-sectional Survey.

BackgroundElectronic health records (EHRs) have been implemented in many low-resource settings but lack strong evidence for usability, use, user confidence, scalability, and sustainability.ObjectiveThis study aimed to evaluate staff use and perceptions of an EHR widely used for HIV care in >300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability.MethodsA randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, use, and attitudes toward the EHR and clinical alerts. This study used the associated randomized clinical trial study sample (56/112, 50% sites received an enhanced EHR), pulling 27 (50%) sites from each group. Free-text comments were analyzed thematically using inductive coding.ResultsOf the 100 participants, 90 (90% response rate) were interviewed at 54 health centers: 44 (49%) participants were clinical and 46 (51%) were technical. The EHR top uses were to access client data easily or quickly (62/90, 69%), update patient records (56/89, 63%), create new patient records (49/88, 56%), generate various reports (38/85, 45%), and review previous records (43/89, 48%). In addition, >90% (81/90) of respondents agreed that the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. Regarding availability, (66/88) 75% said they could always or almost always count on the EHR being available, whereas (6/88) 7% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=.04), generate summaries before (P<.001) or during visits (P=.01), and agree that “the EHR provides useful alerts, and reminders” (P<.01).ConclusionsMost users perceived the EHR as well accepted, appropriate, and effective for use in low-resource settings despite infrastructure limitation in 25% (22/88) of the sites. The implementation of EHR enhancements can improve the perceived usefulness and use of key functions. Successful scale-up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries.

Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards.

This work aims to describe how EHRs have been used to meet the needs of healthcare providers and researchers in a 1,300-beds tertiary Hospital during COVID-19 pandemic. For this purpose, essential clinical concepts were identified and standardized with LOINC and SNOMED CT. After that, these concepts were implemented in EHR systems and based on them, data tools, such as clinical alerts, dynamic patient lists and a clinical follow-up dashboard, were developed for healthcare support. In addition, these data were incorporated into standardized repositories and COVID-19 databases to improve clinical research on this new disease. In conclusion, standardized EHRs allowed implementation of useful multi- purpose data resources in a major Hospital in the course of the pandemic.

Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study.

BackgroundElectronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research.ObjectiveThe aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants’ EHR data for longitudinal research to identify factors affecting their willingness to participate in research.MethodsWe conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison.ResultsParticipants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants’ concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research.ConclusionsThis exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns.

Using electronic health records to monitor, augment and evaluate patient care in Singapore

Abstract The advent of electronic health records (eHRs) has opened up many opportunities for researchers and practitioners in healthcare to improve human lives. The opportunity to monitor and evaluate events or processes in real time on a large scale is feasible with big data, thereby facilitating timely information and the practice of proactive care. Predictive analytics allows the re-engineering of processes by augmenting them with predictive scores to identify individuals at high risk of adverse events for early intervention. However, to seize these opportunities to improve patient care, alleviating the challenges faced when utilizing eHRs to generate actionable insights is important to unleash the full potential of eHRs. With better access to eHRs and relevant domain experts, it facilitates the appropriate use of eHRs and analytical approaches. To illustrate some of these opportunities and challenges, the following two case studies will be discussed during this presentation: (i) programs developed at an academic health system in Singapore that aim to improve the experience and outcomes of inpatients, and (ii) a nationwide Predictive Model for Admission Prevention in Singapore that identifies suitable discharged inpatients for enrolment into a community-centric program.

Using population register data for health services research – the Finnish experience

Abstract The personal identification number was introduced in Finland in the mid-1960s. By 1970, it was universally used in administrative databases including population census, causes of death, cancer, hospital discharge, and health insurance registries. Early on data protection regulations recognised the use of registries and ID numbers for research and register linkages which allowed expanding the use of register data in population health and health services research. The possibility to analyse electronic health records (eHRs) linked to individual whole-population sociodemographic data has allowed the use of a wide range of study designs from cross-sectional to longitudinal studies and to various hierarchical designs. Some registers extend follow-up time up to over 50 years with detailed mapping of individual event histories. Data also allow detailed disentangling of individual and contextual factors, such as socioeconomics and comorbidities vs. provider characteristics. While some data items draw on administrative decisions or clinical discretion, such as granting insurance benefits or decisions on surgery, the research use of the data requires understanding of processes used to construct data items. The use of population registers in health services research is clearly cost-effective. However, the lack of a high-performance computing capacity and environment suitable for processing large sensitive data, as well as inadequate information on the use of primary health care and eHRs has limited efficient use of extensive and complex linkage schemes and the utilisation of machine learning. The Finnish register authorities have improved computing facilities for research use and the legislative reform on secondary use of health care data is opening eHRs for research use granting higher granularity in describing content and quality of care. These developments enable big-data methods to be an essential part of the future methodological toolbox for health service research.

Transparency of Health Informatics Processes as the Condition of Healthcare Professionals’ and Patients’ Trust and Adoption: the Rise of Ethical Requirements

Summary Objectives : To provide an introduction to the 2020 International Medical Informatics Association (IMIA) Yearbook by the editors. Methods : This editorial provides an introduction and overview to the 2020 IMIA Yearbook which special topic is: “Ethics in Health Informatics”. The keynote paper, the survey paper of the Special Topic section, and the paper about Donald Lindberg’s ethical scientific openness in the History of Medical Informatics chapter of the Yearbook are discussed. Changes in the Yearbook Editorial Committee are also described. Results : Inspired by medical ethics, ethics in health informatics progresses with the advances in biomedical informatics. With the wide use of EHRs, the enlargement of the care team perimeter, the need for data sharing for care continuity, the reuse of data for the sake of research, and the implementation of AI-powered decision support tools, new ethics requirements are necessary to address issues such as threats on privacy, confidentiality breaches, poor security practices, lack of patient information, tension on data sharing and reuse policies, need for more transparency on apps effectiveness, biased algorithms with discriminatory outcomes, guarantee on trustworthy AI, concerns on the re-identification of de-identified data. Conclusions : Despite privacy rules rooted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the USA and even more restrictive new regulations such as the EU General Data Protection Regulation published in May 2018, some people do not believe their data will be kept confidential and may not share sensitive information with a provider, which may also induce unethical situations. Transparency on healthcare data processes is a condition of healthcare professionals’ and patients’ trust and their adoption of digital tools.

Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study

BackgroundElectronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs.MethodsA mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process.ResultsOf the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient’s identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis.ConclusionsIn this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.

Electronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements

ObjectiveElectronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. Materials and methodsUniversity Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. ResultsWe identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DiscussionWhile identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. ConclusionThis study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.

End-Point Information Security in the Healthcare Industry: A Critical Review

The ability of the healthcare industry to keep abreast with the evolving trends in endpoint information security depends on combinations of measures. In the current literature, some of these measures include the development of analytics capable of spotting intruders on time, embracing quick reactions to potential or detected intrusions, and the decision to employ robust system defenses. In this paper, the main aim was to review the current literature regarding the subject of endpoint information security, with critical insights gained from the case of the healthcare industry. Findings suggest that the healthcare industry forms one of the most attractive arenas for security attackers. Some of the healthcare organizations that have been victims of recent security attacks include the Californian Hollywood Presbyterian Medical Center that experienced a data breach in February 2016 and MedStar Health Inc. (in the same month). In the following month, San Diego’s Alvaro Hospital Medical Center was also targeted for cyber attack. Hence, some algorithms have been proposed to counter these attacks; including the use of SOA-based EHRs, the implementation of the RBAC model, the use of k-anonymity, k-unlinkability, and the SQL searching mechanisms that target the patients’ encrypted data. Also, some strategies have been proposed as best practices in endpoint information security. These strategies include the management of identity lifecycles, the establishment of risk-aware cultures, the management of third-party security compliance, and securing healthcare firms’ devices in terms of design. Overall, it is evident that the complexity of endpoint information security in the healthcare industry (due to the evolution of applications such as virtualization and cloud computing) implies that the ability to survive from future security attacks will depend on the firms’ ability to keep abreast with industry demands.

Towards a deeper understanding of meaningful use in electronic health records.

The purpose of this study was to identify and analyse the US Health Sector concept of the 'Meaningful Use' of electronic health records (EHR's) based on the wide diversity of discourses in the published literature. Meaningful Use is defined as 'use of digital medical and health records to improve quality, safety and efficiency of patient health information'. Herman Dooyeweerd's philosophical suite of aspects was the chosen research tool used to analyse seminal papers concerning the Meaningful Use of EHRs. The methodology included the identification of the criteria for choosing the papers: application of the criteria to the literature and then selection of the papers and finally the application of Dooyeweerd's aspects to the papers in order to analyse and classify the motivations of the authors. As a result of the aspectual analysis of the relevant texts in the seminal papers, two aspects were identified, one as primary and another one as secondary. In addition, the analytic aspect was repeated twice as the primary aspect. Although there were a number of papers distinctively centred on different aspects, overlaps and similarities were also clearly identified. Dooyeweerd's philosophy is useful in helping to affirm the factors that are important to the authors of the seminal papers and the philosophy helps us to accommodate this diversity in a unique way, therefore enhancing our understanding of approaches in the area. By employing the lens of Dooyeweerd's aspects, the study enhances the understanding of diversity in one discipline and could potentially provide a new system for the classification of diversity within other related disciplines.

The role of electronic health records in clinical reasoning.

Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi-and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation. It concludes with an integrative vision of the use of eHRs, and the special role of the patient, for teaching and learning in medicine.

Extent of Use of Electronic Records in Children's Primary Care and Public Health in Europe.

EHRs are widely seen as a key resource in modern health care. For children not only is primary care vital, but also case-based public health systems can help ensure that all children receive immunisation and other preventive programmes. A European study showed that in 2016 in the 30 EU and EEA countries, 19 countries had widespread use of EHRs in children's primary care, while 20 countries had case-based child public health systems. However, the results show a bias of disadvantage for poorer or smaller countries. More study is needed in this area.

Public and physician’s expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security

IntroductionElectronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. ObjectivesTo record public and physicians’ awareness, expectations for, and ethical concerns about the use of EHRs. MethodsA convenience sample was surveyed for both the public and physicians. The Public’s Questionnaire was distributed to the public in a printed and an online version. The Physicians’ Questionnaire was distributed to physicians in an online version. The questionnaires requested demographic characteristics followed by close-ended questions enquiring about awareness, perceived impact, perceived risks, and ethical issues raised by EHR use. ResultsIn total, 46% of the public and 91% of physicians were aware of EHRs. Physicians’ and public opinions were comparable concerning the positive impact of EHRs on better, more effective, and faster decisions on the patients’ health, on better coordination between hospitals/clinics and on quality and reduced cost of health care. However, physicians were concerned that an EHR system would be a burden for their finances, for their time concerning training on the system, for their everyday workload and workflow. The majority of the public generally agreed that they would worry about the possibility that a non-authorized, third party might gain access to their personal health information (48.8%), and that they would worry about future discriminations due to possible disclosure of their health information (48.8%). Most physicians disagreed that EHRs will disrupt the doctor-patient relationship (58.1%) but they would worry about the safety of their patients’ information (53.1%). Overall, both the public and physicians were in favor of the implementation of an EHR system, evaluating that possible benefits are more important than possible risks. The majority of the public believed that physicians should have full access to an EHR (90.9%), whereas nursing staff, pharmacists, laboratory staff, and other healthcare professional should have partial access. ConclusionsThe factors identified in the present study present actionable insights that may increase awareness about EHRs. The survey illustrates that both the public and physicians acknowledge the benefits and support EHRs on the condition that sufficient guarantees are provided about privacy and security.

Does adoption of electronic health records improve the quality of care management in France? Results from the French e-SI (PREPS-SIPS) study

BackgroundElectronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the “Hôpital numérique 2012–2017” program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. ObjectiveThe aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France. MethodsThis retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, “IPAQSS”), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics. ResultsThe models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology. ConclusionThese results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units.