Beauvais Bradley, Kruse Clemens Scott, Fulton Lawrence, Shanmugam Ramalingam, Ramamonjiarivelo Zo, Brooks Matthew
School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States.
J Med Internet Res. 2021 Apr 14;23(4):e23961. doi: 10.2196/23961.
Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear.
In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance.
This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value-Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure.
None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R=24.3%; β=-.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R=4.2%).
The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.
电子健康记录（EHRs）是急症医院医疗服务的核心特征；然而，与系统性能相关的财务和质量结果仍不明确。
在本研究中，我们旨在评估三大电子健康记录供应商与医院财务及质量绩效指标之间的关联。
本研究评估了2667家以Cerner、Epic或Meditech作为主要电子健康记录系统的医院，并考量了它们在净利润、基于医院价值购买的总体绩效得分（TPS）以及效率和成本降低、临床护理、以患者和照护者为中心的体验、患者安全等未加权子领域方面的表现。我们假设这三家供应商在各项指标上存在差异。
在我们的研究中，没有一个电子健康记录系统与具有统计学意义的财务关系相关。Epic与TPS结果呈正相关（R = 23.6%；β = 0.0159，标准误0.0079；P = 0.04），且患者对质量的感知较高（R = 29.3%；β = 0.0292，标准误0.0099；P = 0.003），但与患者安全质量得分呈负相关（R = 24.3%；β = -0.0221，标准误0.0102；P = 0.03）。Cerner和Epic与效率提高呈正相关（R = 31.9%；Cerner：β = 0.0330，标准误0.0135，P = 0.01；Epic：β = 0.0465，标准误0.0133，P < 0.001）。最后，所有三家供应商在临床护理领域均表现出积极绩效（Epic：β = 0.0388，标准误0.0122，P = 0.002；Cerner：β = 0.0283，标准误0.0124，P = 0.02；Meditech：β = 0.0273，标准误0.0123，P = 0.03），但解释力较低（R = 4.2%）。
本研究结果表明三大电子健康记录供应商在临床结果表现上存在差异，可为医疗保健领导者将未来资本投资目标设定为改善医疗服务提供支持性证据。
