Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch).
Psychiatr Serv. 2021 Dec 1;72(12):1370-1376. doi: 10.1176/appi.ps.202000816. Epub 2021 Apr 15.
Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals.
Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse.
Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79).
Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.
大多数美国急症护理医院已采用基本电子健康记录（EHR）功能和健康信息交换（HIE）（分别为 84%和 88%，均在 2017 年）。本研究旨在检验医院基于物质使用障碍计划的 EHR 和 HIE 采用率是否低于急症护理医院。
对 2017 年国家物质滥用治疗服务调查的数据进行分析，以考察医院为基础的物质使用障碍计划采用基本 EHR 功能（即评估、进度监测、出院、实验室和处方配药）和使用 HIE 的情况。分析采用加权多变量 EHR 和 HIE 结果模型，对无应答情况进行调整。
在 894 家具有 EHR 信息的医院为基础的物质使用障碍计划中，有三分之二（N=606，68%）报告采用了基本 EHR 功能。与急症护理医院相比，精神病医院采用 EHR 的可能性较小（优势比[OR]=0.49，95%置信区间[CI]=0.35-0.71）。与非营利性医院相比，营利性（OR=0.23，95% CI=0.16-0.35）和政府所有的（OR=0.52，95% CI=0.33-0.83）医院采用基本 EHR 功能的可能性较小。为酒精或阿片类药物使用障碍提供药物治疗的医院比不提供此类药物治疗的医院更有可能采用基本 EHR（OR=1.95，95% CI=1.31-2.90）。在有 HIE 使用信息的 839 家医院中，有 598 家（71%）报告使用了电子 HIE。采用基本 EHR 功能是使用 HIE 的最强预测因子（OR=4.73，95% CI=3.29-6.79）。
美国医院为基础的物质使用障碍计划在采用基本 EHR 和电子 HIE 方面落后于急症护理医院。这些发现令人担忧，因为它们错过了改善医院为基础的物质使用障碍护理质量和绩效衡量的机会。
