Sunny C. Lin is a doctoral candidate in the Department of Health Management and Policy, University of Michigan, in Ann Arbor.
Ashish K. Jha is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health, in Boston, and director of the Harvard Global Health Institute, in Cambridge, both in Massachusetts.
Health Aff (Millwood). 2018 Jul;37(7):1128-1135. doi: 10.1377/hlthaff.2017.1658.
Evidence linking electronic health record (EHR) adoption to better care is mixed. More nuanced measures of adoption, particularly those that capture the common incremental approach of adding functions over time in US hospitals, could help elucidate the relationship between adoption and outcomes. We used data for the period 2008-13 to assess the relationship between EHR adoption and thirty-day mortality rates. We found that baseline adoption was associated with a 0.11-percentage-point higher rate per function. Over time, maturation of the baseline functions was associated with a 0.09-percentage-point reduction in mortality rate per year per function. Each new function adopted in the study period was associated with a 0.21-percentage-point reduction in mortality rate per year per function. We observed effect modification based on size and teaching status, with small and nonteaching hospitals realizing greater gains. These findings suggest that national investment in hospital EHRs should yield improvements in mortality rates, but achieving them will take time.
电子健康记录（EHR）采用与改善护理之间的关联证据不一。更细致的采用措施，特别是那些能够捕捉到美国医院随时间增加功能的常见渐进方法的措施，可能有助于阐明采用与结果之间的关系。我们使用了 2008 年至 2013 年的数据来评估 EHR 采用与三十天死亡率之间的关系。我们发现，基础采用率与每增加一个功能就会增加 0.11 个百分点的死亡率相关。随着时间的推移，基础功能的成熟与每年每个功能死亡率降低 0.09 个百分点相关。在研究期间采用的每个新功能与每年每个功能死亡率降低 0.21 个百分点相关。我们观察到基于规模和教学状态的效果修饰，小医院和非教学医院的收益更大。这些发现表明，国家对医院 EHR 的投资应该会提高死亡率，但要实现这一目标需要时间。
