Dataset Information

Sequencing of EHR adoption among US hospitals and the impact of meaningful use.

ABSTRACT:

Objective

To examine whether there is a common sequence of adoption of electronic health record (EHR) functions among US hospitals, identify differences by hospital type, and assess the impact of meaningful use.

Materials and methods

Using 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data, we calculate adoption rates of individual EHR functions, along with Loevinger homogeneity (H) coefficients, to assess the sequence of EHR adoption across hospitals. We compare adoption rates and Loevinger H coefficients for hospitals of different types to assess variation in sequencing. We qualitatively assess whether stage 1 meaningful use functions are those adopted early in the sequence.

Results

There is a common sequence of EHR adoption across hospitals, with moderate-to-strong homogeneity. Patient demographic and ancillary results functions are consistently adopted first, while physician notes, clinical reminders, and guidelines are adopted last. Small hospitals exhibited greater homogeneity than larger hospitals. Rural hospitals and non-teaching hospitals exhibited greater homogeneity than urban and teaching hospitals. EHR functions emphasized in stage 1 meaningful use are spread throughout the scale.

Discussion

Stronger homogeneity among small, rural, and non-teaching hospitals may be driven by greater reliance on vendors and less variation in the types of care they deliver. Stage 1 meaningful use is likely changing how hospitals sequence EHR adoption--in particular, by moving clinical guidelines and medication computerized provider order entry ahead in sequence.

Conclusions

While there is a common sequence underlying adoption of EHR functions, the degree of adherence to the sequence varies by key hospital characteristics. Stage 1 meaningful use likely alters the sequence.

SUBMITTER: Adler-Milstein J

PROVIDER: S-EPMC4215052 | biostudies-literature | 2014 Nov-Dec

REPOSITORIES: biostudies-literature

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Publications

Sequencing of EHR adoption among US hospitals and the impact of meaningful use.

Adler-Milstein Julia J Everson Jordan J Lee Shoou-Yih D SY

Journal of the American Medical Informatics Association : JAMIA 20140522 6

<h4>Objective</h4>To examine whether there is a common sequence of adoption of electronic health record (EHR) functions among US hospitals, identify differences by hospital type, and assess the impact of meaningful use.<h4>Materials and methods</h4>Using 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data, we calculate adoption rates of individual EHR functions, along with Loevinger homogeneity (H) coefficients, to assess the sequence of EHR adoption across hospi ...[more]

PMID: 24853066

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Project description:BACKGROUND:The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. OBJECTIVE:To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation. METHODS:We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit. RESULTS:We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation. CONCLUSION:Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.

Dataset Information

Sequencing of EHR adoption among US hospitals and the impact of meaningful use.

Objective

Materials and methods

Results

Discussion

Conclusions

Publications

Sequencing of EHR adoption among US hospitals and the impact of meaningful use.

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