Researchers recently found that hospitals opting to switch from hardcopies to electronic health records may eventually see lower death rates.  However, a nationwide study has also suggested that fatalities may increase as the transition begins and before it concludes.  The degree of digitization and thirty-day death rates for patients age 65 and older at 3,249 hospitals nationwide from 2008 to 2013 were reviewed.  Many hospitals didn’t make the transition to an electronic repository until after 2009 when the U.S. government set aside $30 billion for health technology.In the beginning of this period, for every electronic health function that was already fully implemented, hospitals had 0.11 additional deaths per 100 patient admissions – a 0.11 percentage-point higher mortality rate.  Over time, however, each of the functions adopted were associated with a 0.09 percentage point dip in the annual death rate.  What’s more, every new function added was also associated with a 0.21 percentage-point reduction in the annual rate.“Our overall findings were driven by what was happening in small and non-teaching hospitals,” and not at all educational centers, said Julia Adler-Milstein of the University of California, San Francisco. “So, for patients considering care at these types of hospitals, it might be good to know how digital they are and then, if there is a need to receive hospital care and the patient has a say in where that occurs, pick a hospital that is more digital and has been digital for longer.”With the limited resources the team had for the sample study, they were made to presume the larger and academic hospitals had ongoing quality improvement efforts, leaving less room to show mortality benefits once digital record-keeping was implemented.  For smaller community hospitals, however, adopting electronic health records likely improved the quality of patient care.

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Hospitals can take steps to make the transition a seamless one, said Ann Kutney-Lee, a researcher at the University of Pennsylvania School of Nursing in Philadelphia who wasn't involved in the study.  “The initial stages of adopting and implementing EHRs can cause unintended consequences and significant disruptions in clinical workflow processes that can affect the delivery of safe patient care, including, but not limited to, communication between providers, access to patient records and test results, medication order entry, and medication administration records…To avoid these potential negative effects, hospitals should ensure that adequate supports and resources are in place prior to and throughout the time of adoption or modification of an EHR system and that contingency plans are in place for when the EHR is not working,” she said.“EHR adoption was a big shock in many ways to the practice of medicine,” said A. Jay Holmgren, a researcher at Harvard Business School in Boston who wasn't involved in the study. “It isn’t surprising that there was an initial learning curve for hospitals.”  Now that most hospitals have completed the transition, however, “patients have little to worry over with regards to EHR adoption and choosing a hospital,” according to Holmgren.Dean Sittig, a researcher at the University of Texas Health Science Center at Houston, added, “Implementing EHRs is difficult and time-consuming, but well worth the effort.  Gains are made slowly but surely over time.”

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Switch to electronic health records tied to fewer hospital deathsReducing Medical Errors with Improved Communication, EHR Use