Can EHRs Prevent Adverse Events?

Cardiovascular, surgery, and pneumonia patients whose complete treatment was captured in a fully installed electronic health record (EHR) were 17% to 30% less likely to experience in-hospital adverse events (AEs), according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ), published online ahead of print in The Journal of Patient Safety. The findings suggest that better coordinated care from admission to discharge reduces the risk of harm reaching patients, AHRQ concludes.

AHRQ investigators led by Michael F. Furukawa, PhD, examined whether there was an association between hospitals’ EHR adoption and occurrence rates of 21 hospital AE measures considered to be bellwethers of patient safety.

Their retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System included patients 18 years of age and older who were hospitalized for acute cardiovascular disease, pneumonia, or conditions requiring surgery. In-hospital AEs, including hospital-acquired infections (such as central line-associated bloodstream infections; adverse drug events, general events (such as falls and pressure ulcers), and postprocedural events (such as blood clots) were the study’s main outcome measures.

Researchers measured to what extent care received by patients in 1351 hospitals was captured by a fully electronic EHR. Hospital care was categorized as fully electronic (all physician notes, nursing assessments, problem lists, medication lists, discharge summaries, and provider orders are electronically generated), partially electronic (some but not all of those components are electronically generated), and nonelectronic (none of these components are present).

Among patients in the study sample, 347,281 exposures to AEs occurred. Of these, 7820 AEs actually took place, resulting in a 2.25% occurrence rate of events for which patients were at risk.

Occurrence rates were highest among patients hospitalized for pneumonia and lowest among patients requiring surgery. Thirteen percent (5876 patients) received care that was captured by a fully electronic EHR. Although these patients had lower odds of any AE, this association varied by medical condition and type of AE:

• Patients hospitalized for pneumonia and exposed to a fully electronic EHR had a 35% lower risk of adverse drug events, a 34% lower risk of hospital-acquired infections, and 25% lower risk of general events.
• Patients hospitalized for cardiovascular surgery and exposed to a fully electronic EHR had a 31% lower risk of postprocedural events and 21% fewer general events.
• Among patients hospitalized for surgery, fully electronic EHRs were associated with a 36% lower risk of hospital-acquired infections.

The authors conclude that EHRs can play a key role in preventing AEs.

“Adoption of EHRs can better manage the multiple tasks that prevent AEs before they can occur, keeping patients safer as a result,” they wrote.