Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record AdoptionModel (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital's electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012-2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959-0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,9150,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider's efforts to achieve desired quality outcomes and efficiency in Western European hospitals

Interoperability between health information systems in the hospital context

The information systems had a positive effect on the health service by reducing the physical documentation, more available information to monitor the patient and safer data storage. On the other hand, there was a negative impact due to an increase of diverse systems operating which demanded more training and support to hospitals structure aligned with the lack of interoperability standards that promote the patient´s data sharing between them. Therefore, this dissertation focused on analysing the existent interoperability between information systems in the Portuguese health service, determine the key aspects to establish communication among them, and the consequences it has on the healthcare professional´s routines. Interviews were conducted with healthcare professionals and hospital suppliers to collect their experience on interacting with this technology, their opinion about the influence it has on the hospital´s routine, and the potential measures to improve the current situation. This research concluded that the lack of interoperability and an unfriendly interface generates a complex use of the systems with a high number of clicks and slower navigation to execute the tasks that can cause loss of time for healthcare professionals. Besides, the public hospital demonstrated to have a higher number of IS suppliers and lower levels of integration between systems compared with private hospitals. Lastly, it was demonstrated that an organisational culture oriented to the technology change and a strategic plan to adapt to the hospital's approach is necessary to a successful implementation of health information systems.Os sistemas de informação tiveram um efeito positivo no serviço de saúde com redução na documentação em papel, maior disponibilidade de informação sobre o paciente e segurança no armazenamento de dados. Por outro lado, houve um impacto negativo devido ao aumento na diversidade de sistemas a operar, que exigiram mais treino e apoio à estrutura hospitalar, associado à falta de padrões de interoperabilidade que promovam a partilha de dados do paciente. Assim, esta dissertação centra-se na análise da interoperabilidade existente entre os sistemas de informação no serviço de saúde português, em determinar os aspetos fundamentais para estabelecer a comunicação entre os mesmos e as consequências que têm na rotina do profissional de saúde. Foram realizadas entrevistas com profissionais da área e fornecedores hospitalares para recolher informação sobre a experiência na interação com esta tecnologia, a opinião sobre a influência que ela exerce na rotina hospitalar e as possíveis medidas para melhorar a atual situação. Esta investigação concluiu que a falta de interoperabilidade e uma interface pouco apelativo determinam um uso complexo destes sistemas com um elevado número de cliques e uma navegação mais lenta para executar as tarefas, que podem causar perda de tempo aos profissionais de saúde. Além disso, os hospitais públicos demonstram ter um maior número de fornecedores e menores níveis de integração entre os sistemas em comparação com os privados. Por fim, expõem-se que uma cultura organizacional direcionada para a mudança tecnológica e um plano estratégico de adaptação são necessários para o sucesso da implantação destes sistemas

An analysis of the effects of certified electronic health records on organizations and patients.

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay (LOS) and patient generated health data (PGHD), the relationship between hospital utilization of certified EHRs and LOS, and the relationship between hospital utilization of certified EHRs with hospital capability of allowing the function of PGHD. The first analysis was a scoping review guided by the PRISMA protocol to explore what is known of the effects of certified EHRs on LOS and PGHD. The second analysis used datasets from the American Hospital Association Survey and Information Technology Supplement and Kentucky Cabinet for Health and Family Services, Office of Health Policy from 2015 to 2019 to understand the relationship between hospital utilization of certified EHRs and LOS through a fixed effects regression model. The final paper analysis used datasets from the American Hospital Association Survey and Information Technology Supplement from 2016 to 2020 to understand the relationship between hospital utilization of certified EHRs and the function of enabling PGHD through a binary logistic regression. There is support amongst researchers on EHRs improving quality, such as, LOS and the function of PGHD improving technology efficiency and others supporting EHRs with more customization and open architecture. There is less known about whether an EHR, certified or non-certified, are different from one another with providing advantages for hospitals. Hospitals with certified EHRs have a longer LOS compared to hospitals with non-certified EHRs. Most hospitals experienced barriers with receiving, sending, or other electronic information exchange. Most hospitals with certified EHRs were more likely to not enable the function for PGHD compared to hospitals with non-certified EHRs. EHRs can be problematic while hospitals are providing hospital care. Although most hospitals possess certified EHRs, most do not enable the function of PGHD. Secondary sources from the survey were completed by the Chief Technology Officer or Chief Information Officer. Further research could be continued with understanding different groups’ health effects with health information technology. Hospitals may be satisfied with their EHRs but not as abreast on how functional the EHR is and how the EHR can benefit patients

The Relationship Between Hospitals’ Electronic Health Records Maturity and Excess Readmission Ratio

Since the Health Information Technology for Economic and Clinical Health Act was enacted in 2009, a majority of U.S. hospitals have adopted electronic health records (EHR) to improve quality of care. However, variations exist in the technology\u27s capability and maturity, making it difficult for researchers to analyze the full impact. The purpose of this quantitative study was to explore the relationship between hospitals\u27 EHR maturity and the quality measure of excess readmissions, as well as the relationship between hospital characteristics, specifically, hospital location and the number of licensed beds in Medicare hospitals (N = 1,006). Both the chi-square statistical test and logistic regression models were used to analyze whether EHR maturity has an impact on excess readmissions. Rogers\u27s diffusion of innovation provided the theoretical framework. A retrospective data analysis for FY 2017 was conducted using EHR adoption analytics from the Healthcare Information and Management Systems Society and excess readmission ratio (ERR) data from the Centers for Medicare and Medicaid Services’ Hospital Readmissions Reduction Program. Analyses indicated no significant association between EHR maturity and ERR for either coronary artery bypass grafts or total hip or total knee arthroplasty (THA/TKA). However, there was a significant relationship between hospitals\u27 EHR maturity, location, and number of licensed beds. In addition, EHR maturity and hospitals\u27 location were significant predictors of elective primary THA/TKA ERR. The results of this study may lead to positive social change by informing hospital administrators on the impact of investments in mature EHR technology to reduce excess readmissions and improve quality of care