Mr. Jarvis is administrative fellow, NorthShore University HealthSystem, Evanston, Illinois. Dr. Johnson is associate chair of research and education and associate professor, Department of Health Systems Management, and director, Rush Center for the Advancement of Healthcare Value, Rush University, Chicago, Illinois. Mr. Butler is president and chief operating officer, Rush University Medical Center, and chairman and associate professor, Department of Health Systems Management, Rush University, Chicago, Illinois. Ms. O'Shaughnessy is adjunct faculty, Department of Health Systems Management, Rush University, Chicago, Illinois, and project manager, Quality Operations, University HealthSystem Consortium, Chicago, Illinois. Mr. Fullam is senior director of marketing research in strategic planning, marketing, and program development and senior director of patient relations in performance improvement and clinical effectiveness, Rush University Medical Center, and assistant professor, Department of Health Systems Management, Rush University, Chicago, Illinois. Mr. Tran is senior vice president and chief information officer, Rush University Medical Center, and instructor, Department of Health Systems Management, Rush University, Chicago, Illinois. Ms. Gupta is associate vice president of performance improvement and clinical effectiveness, Rush University Medical Center, and adjunct faculty, Department of Health Systems Management, Rush University, Chicago, Illinois.
Acad Med. 2013 Oct;88(10):1471-7. doi: 10.1097/ACM.0b013e3182a36cab.
To assess the impact of using an advanced electronic health record (EHR) on hospital quality and patient satisfaction.
This retrospective, cross-sectional analysis was conducted in 2012 to evaluate the association between advanced EHR use (Healthcare Information Management Systems Society [HIMSS] Stage 6 or 7 as of December 2012) and estimated process and experience of care scores for hospitals under the Medicare Hospital Value-Based Purchasing Program, using data from the American Hospital Association for 2008 to 2010. Generalized linear regression models were fit to test the association between advanced EHR use with process of care and experience of care, controlling for hospital characteristics. In a second analysis, the models included variables to account for HIMSS stage of advanced EHR use.
The study included 2,988 hospitals, with 248 (8.3%) classified as advanced EHR users (HIMSS Stage 6 or 7). After controlling for hospital characteristics, advanced EHR use was associated with a 4.2-point-higher process of care score (P < .001). Hospitals with Stage 7 EHRs had 11.7 points higher process of care scores, but Stage 6 users had scores that were not substantially different from those of nonadvanced users. There was no significant difference in estimated experience of care scores by level of advanced EHR use.
This study evaluated the effectiveness of the U.S. federal government's investment in hospital information technology infrastructure. Results suggest that the most advanced EHRs have the greatest payoff in improving clinical process of care scores, without detrimentally impacting the patient experience.
评估使用先进电子健康记录（EHR）对医院质量和患者满意度的影响。
本回顾性、横断面分析于 2012 年进行，旨在评估先进 EHR 使用（截至 2012 年 12 月，医疗保健信息管理系统协会 [HIMSS] 第 6 或 7 阶段）与医疗保险医院价值采购计划下医院的护理过程和体验估计得分之间的关联，使用 2008 年至 2010 年美国医院协会的数据。广义线性回归模型用于检验先进 EHR 使用与护理过程和护理体验之间的关联，控制医院特征。在第二次分析中，模型纳入了变量，以说明先进 EHR 使用的 HIMSS 阶段。
研究纳入了 2988 家医院，其中 248 家（8.3%）被归类为先进 EHR 用户（HIMSS 第 6 或 7 阶段）。在控制医院特征后，先进 EHR 使用与护理过程得分提高 4.2 分相关（P <.001）。使用第 7 阶段 EHR 的医院护理过程得分高出 11.7 分，但第 6 阶段用户的得分与非先进用户没有明显差异。按先进 EHR 使用水平，估计的护理体验得分没有显著差异。
本研究评估了美国联邦政府对医院信息技术基础设施投资的效果。结果表明，最先进的 EHR 在提高临床护理过程得分方面收效最大，而不会对患者体验产生不利影响。
