At Texas hospitals that have automated some aspects of their information systems, patients appear to have fewer complications, lower death rates and reduced costs, according to a report in the Jan. 26 issue of Archives of Internal Medicine.
"Clinical or 'health' information technologies, such as electronic medical records, computerized provider order entry systems and clinical decision support systems, have emerged as one antidote, promising reductions in waste, gains in communication, improvements in quality and new accountabilities through automated performance measurement,” the authors wrote.
A hospital's clinical information system can be divided into four categories: medical notes and records, test results, order entry (instructions for the treatment of patients) and decision support (programs that assist physicians and other providers with decision-making tasks), according to the investigators.
Ruben Amarasingham, MD, of Parkland Health & Hospital System and University of Texas Southwestern Medical Center in Dallas, and colleagues compared urban hospitals in Texas using a tool that measures physicians' interactions with the information system.
Physicians from 41 hospitals rated their facilities' automation in each of the four areas in surveys taken in 2005 and 2006. The researchers then examined rates of inpatient death, complications, costs and length of stay for 167,233 patients older than 50, who were admitted to the hospital for a variety of conditions during the same timeframe.
For all of the medical conditions studied, increased automation of notes and records was associated with a 15 percent decrease in the odds of in-hospital death. At hospitals with higher order entry scores, those with heart attack had 9 percent lower odds of death and those undergoing coronary artery bypass graft had 55 percent lower odds of death. Patients with all causes of hospitalization had 16 percent lower odds of developing complications at hospitals whose decision support systems were highly automated.
"Higher scores on test results, order entry and decision support were associated with lower costs for all hospital admissions (-$110, -$132 and -$538, respectively)," the authors wrote.
"Clinical information technologies hold great promise as a tool to improve hospital medicine," the researchers concluded. "We found that, for certain conditions, greater automation of a hospital's information system may be associated with reductions in mortality [death], complications and costs, suggesting that information technologies that are properly designed and executed around clinical workflows could meet that promise."
"At the end of the day, does this article mean that hospitals should now climb on the health information technology bandwagon?,” wrote David W. Bates, MD, of Brigham and Women's Hospital in Boston, in an accompanying editorial.
"More of such analyses should be done, and they are likely to be helpful in convincing policy experts including skeptics like those at the Congressional Budget Office of the benefits when these technologies are in routine use,” Bates added.
“For large- and medium-sized hospitals, it appears that the time is now,” he concluded.
A grant from the Commonwealth Fund in New York City supported the study.