MedicalResearch.com Interview with:
Mr. Noel Eldridge
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality
Medical Research: What is the background for this study? What are the main findings?
Mr. Eldridge: We used existing data on adverse events from the Medicare Patient Safety Monitoring System, which AHRQ, CMS, and Qualidigm have been analyzing for years, and focused on the question as to whether rates of the adverse event measures were higher or lower in patients whose charts indicated that they had been treated with a full electronic health record (EHR) or a partial EHR during their inpatient stay.
The main finding was that the adverse event rates were lower in the full EHR patients. We saw three different diagnosis groups of patients (cardiovascular, pneumonia, and major surgery), and looked at combined rates for all adverse event types, as well as for four combined subtypes separately: hospital-acquired infections, adverse drug events, post-procedural events, and falls and pressure ulcers combined. Not all of our findings were what people unfamiliar with our measures would have expected.
Medical Research: What should clinicians and patients take away from your report?
Mr. Eldridge: There is reason to believe that using a full electronic health record leads to fewer adverse events occurring during inpatient stays at least for the types of events we measured. I think it also shows that transitioning to a full EHRs from a partial electronic health record may be important. Of the more than 1,300 hospitals in our sample, less than 1 percent appeared to have non-electronic health records, but only about 13 percent were fully electronic, and about 86 percent were partially electronic. In the paper, we provided the summary characteristics of what we considered to be a fully electronic health record.
Medical Research: What recommendations do you have for future research as a result of this study?
Mr. Eldridge: The Institute of Medicine and other groups have provided numerous recommendations with respect to EHRs. I’d like to see researchers try to do similar studies that include types of events that we couldn’t measure, such as adverse drug events tied to process errors, or diagnostic errors, and to see if these are less frequent with full EHRs too. Previous studies have shown that bar-code medication administration is effective to reduce medication administration errors, but I’m not sure about other types of medication process-related errors. It would also be interesting to see people interested in specific types of events do detailed work on their event types of interest and EHRs, for example pressure ulcers and infections, and to see if they get results like the ones we did. They might be able to add insight as to how the EHRs might be helping in non-obvious ways within their specialty areas.
Medical Research: Is there anything else you would like to add?
Mr. Eldridge: Like any new technology, EHRs can introduce new ways to make mistakes, but I think that this paper supports the notion that fully-implemented EHRs are almost certainly doing more good than harm. When I worked on an EHR-troubleshooting project 15 years ago in the Veterans Health Administration (VHA), there were all sorts of issues we itemized to be addressed and proceeded to work to fix throughout the system, but even before we addressed the issues, it was clear to me when I listened to physicians and nurses describe the problems, none of them had any doubt that the VHA’s EHR was already making care safer and better overall.
Mr. Noel Eldridge (2015). Fully Integrated Electronic Records Linked to Fewer Inpatient Adverse Effects