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Vogel J, Haering A, Kuklinski D, Geissler A. Assessing the Relationship between Hospital Process Digitalization and Hospital Quality - Evidence from Germany. J Med Syst 2024; 48:85. [PMID: 39269612 PMCID: PMC11399181 DOI: 10.1007/s10916-024-02101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 08/21/2024] [Indexed: 09/15/2024]
Abstract
Hospital digitalization aims to increase efficiency, reduce costs, and/ or improve quality of care. To assess a digitalization-quality relationship, we investigate the association between process digitalization and process and outcome quality. We use data from the German DigitalRadar (DR) project from 2021 and combine these data with two process (preoperative waiting time for osteosynthesis and hip replacement surgery after femur fracture, n = 516 and 574) and two outcome quality indicators (mortality ratio of patients hospitalized for outpatient-acquired pneumonia, n = 1,074; ratio of new decubitus cases, n = 1,519). For each indicator, we run a univariate and a multivariate regression. We measure process digitalization holistically by specifying three models with different explanatory variables: (1) the total DR-score (0 (not digitalized) to 100 (fully digitalized)), (2) the sum of DR-score sub-dimensions' scores logically associated with an indicator, and (3) sub-dimensions' separate scores. For the process quality indicators, all but one of the associations are insignificant. A greater DR-score is weakly associated with a lower mortality ratio of pneumonia patients (p < 0.10 in the multivariate regression). In contrast, higher process digitalization is significantly associated with a higher ratio of decubitus cases (p < 0.01 for models (1) and (2), p < 0.05 for two sub-dimensions in model (3)). Regarding decubitus, our finding might be due to better diagnosis, documentation, and reporting of decubitus cases due to digitalization rather than worse quality. Insignificant and inconclusive results might be due to the indicators' inability to reflect quality variation and digitalization effects between hospitals. For future research, we recommend investigating within hospital effects with longitudinal data.
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Affiliation(s)
- Justus Vogel
- Chair of Health Economics, Policy, and Management, School of Medicine, University of St. Gallen, St.-Jakob-Strasse 21, CH-9000, St. Gallen, Switzerland.
| | - Alexander Haering
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, 45128, Essen, Germany
| | - David Kuklinski
- Chair of Health Economics, Policy, and Management, School of Medicine, University of St. Gallen, St.-Jakob-Strasse 21, CH-9000, St. Gallen, Switzerland
| | - Alexander Geissler
- Chair of Health Economics, Policy, and Management, School of Medicine, University of St. Gallen, St.-Jakob-Strasse 21, CH-9000, St. Gallen, Switzerland
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Woods L, Eden R, Green D, Pearce A, Donovan R, McNeil K, Sullivan C. Impact of digital health on the quadruple aims of healthcare: A correlational and longitudinal study (Digimat Study). Int J Med Inform 2024; 189:105528. [PMID: 38935999 DOI: 10.1016/j.ijmedinf.2024.105528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Digital healthcare aims to deliver on the quadruple aim: enhance patient experiences, improve population health, reduce costs and improve provider experiences. Despite large investments, it is unclear how advancing digital health enables these healthcare aims. OBJECTIVE Our objectives were to: 1) measure the correlation between digital capability and health system outcomes mapped to the quadruple aim, and 2) measure the longitudinal impact of electronic medical record implementations upon health system outcomes. MATERIALS AND METHODS We undertook two studies: 1) Digital health correlational study investigating the association among healthcare system capability and healthcare aims, and 2) Digital hospital longitudinal study investigating outcomes pre and post electronic medical record implementation. RESULTS Digital health capability was associated with lower staff turnover. Digitising healthcare services was associated with decreased medication errors, decreased nosocomial infections, increased hospital activity, and a transient increase in staff leave. DISCUSSION These results suggest positive impacts on the population health and healthcare costs aim, minimal impacts on the provider experience aim and no observed impacts to the patient experience aim. CONCLUSION These findings should provide confidence to healthcare decision-makers investing in digital health.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Digital Health Cooperative Research Centre, Sydney, Australia.
| | - Rebekah Eden
- UQ Business School, Faculty of Business, Economics, and Law, The University of Queensland, Brisbane, Australia
| | | | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | | | - Keith McNeil
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Metro North Hospital and Health Service, Brisbane, Australia
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Dayama N, Pradhan R, Davlyatov G, Weech-Maldonado R. Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes. J Multidiscip Healthc 2024; 17:2577-2589. [PMID: 38803618 PMCID: PMC11129737 DOI: 10.2147/jmdh.s457420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The nursing home (NH) industry operates within a two-tiered system, wherein high Medicaid NHs which disproportionately serve marginalized populations, exhibit poorer quality of care and financial performance. Utilizing the resource-based view of the firm, this study aimed to investigate the association between electronic health record (EHR) implementation and financial performance in high Medicaid NHs. A positive correlation could allow high Medicaid NHs to leverage technology to enhance efficiency and financial health, thereby establishing a business case for EHR investments. Methods Data from 2017 to 2018 were sourced from mail surveys sent to the Director of Nursing in high Medicaid NHs (defined as having 85% or more Medicaid census, excluding facilities with over 10% private pay or 8% Medicare), and secondary sources like LTCFocus.org and Centers for Medicare & Medicaid Services cost reports. From the initial sample of 1,050 NHs, a 37% response rate was achieved (391 surveys). Propensity score inverse probability weighting was used to account for potential non-response bias. The independent variable, EHR Implementation Score (EIS), was calculated as the sum of scores across five EHR functionalities-administrative, documentation, order entry, results viewing, and clinical tools-and reflected the extent of electronic implementation. The dependent variable, total margin, represented NH financial performance. A multivariable linear regression model was used, adjusting for organizational and market-level control variables that may independently affect NH financial performance. Results Approximately 76% of high Medicaid NHs had implemented EHR either fully or partially (n = 391). The multivariable regression model revealed that a one-unit increase in EIS was associated with a 0.12% increase in the total margin (p = 0.05, CI: -0.00-0.25). Conclusion The findings highlight a potential business case -long-term financial returns for the initial investments required for EHR implementation. Nonetheless, policy interventions including subsidies may still be necessary to stimulate EHR implementation, particularly in high Medicaid NHs.
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Affiliation(s)
- Neeraj Dayama
- Department of Healthcare Management and Leadership, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Ganisher Davlyatov
- Department of Health Administration & Policy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
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Vogel J, Hollenbach J, Haering A, Augurzky B, Geissler A. The association of hospital profitability and digital maturity - An explorative study using data from the German DigitalRadar project. Health Policy 2024; 142:105012. [PMID: 38422802 DOI: 10.1016/j.healthpol.2024.105012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION German hospitals largely rely on public investments for digitization. As these have been insufficient, hospitals had to use own profits to foster digital transformation. Thus, we assess if profitability affects digital maturity, and what other factors might be influential. METHODS We use digital maturity data from the DigitalRadar (DR) project (2021) and financial statement data from the Hospital Rating Report from 2017 to 2019 (n = 860). We run linear regressions with the DR-score (continuous variable from 0 to 100) as dependent and three-year average EBITDA margin as independent variable. Besides, we conduct subgroup analyses stratifying by chain size. RESULTS A one percentage point EBITDA margin increase is associated with a 0.359 points DR-score increase (p<0.01). This relationship holds in significance and holds or increases in magnitude for all specifications except when adding chain beds (0.212 point DR-score increase, p<0.05). Besides, chain membership and chain size are positively and significantly associated with hospitals' DR-score. EBITDA margins of the subgroups "large chains" and "Big 3″, i.e., the three largest chains, were strongly associated with the DR-score (2.685 and 3.197 points DR-score increase respectively, p<0.01). CONCLUSIONS Higher profitability is associated with higher digital maturity. Larger chains are digitally more mature, because (1) they might follow a chain-wide IT-strategy, (2) can standardize IT-architecture, and policies and (3) might cross-finance investments.
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Affiliation(s)
- Justus Vogel
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, CH-9000 St. Gallen, Switzerland.
| | - Johannes Hollenbach
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Alexander Haering
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Boris Augurzky
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Alexander Geissler
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, CH-9000 St. Gallen, Switzerland
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Modi S, Feldman SS, Berner ES, Schooley B, Johnston A. Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study. JMIR Med Inform 2024; 12:e52524. [PMID: 38265848 PMCID: PMC10851116 DOI: 10.2196/52524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. OBJECTIVE This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. METHODS We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. RESULTS A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. CONCLUSIONS This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.
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Affiliation(s)
- Shikha Modi
- The University of Alabama in Huntsville, Huntsville, AL, United States
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sue S Feldman
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eta S Berner
- The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Allen Johnston
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
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Pai DR, Dissanayake CK, Anna AM. A comparison of critical access hospitals and other rural acute care hospitals in Pennsylvania. J Rural Health 2023; 39:719-727. [PMID: 36916142 DOI: 10.1111/jrh.12755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE As the Flex Program celebrates its 25th anniversary, we examined changes in critical access hospital (CAH) financial performance, investigated whether CAH status has reduced hospitals' financial vulnerability, and identified factors influencing financial performance. METHODS We collected data on acute care hospitals in Pennsylvania's rural counties for 2000-20. Our sample contained 1,444 hospital-year observations. We used trend analysis to compare the financial performance of CAHs and rural prospective payment system (PPS) hospitals (non-CAHs). We investigated the effect of CAH status on financial performance and identified the time-variant factors impacting financial performance using fixed-effects regression analysis. RESULTS The median total margin of CAHs lagged behind that of non-CAHs. When compared to non-CAH costs over the same period, the median cost per patient day incurred by CAHs has increased, with the rate of increase being significantly higher in the most recent decade. Our findings show that while CAH status does not appear to have a direct impact on the total margin, it is significantly associated with a higher cost per patient day. CONCLUSIONS CAHs in Pennsylvania appear to be facing a double whammy of declining margins and rising costs compared to non-CAHs. Our findings demonstrate how crucial the Flex program has been in sustaining CAHs in Pennsylvania ever since its inception. Our findings have implications for rural health care delivery as well. While providing financial support and operational flexibility to CAHs should be a continuing policy priority, a long-term policy goal should be to envision an economic development strategy that capitalizes on the unique strengths of each of the rural archetypes.
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Affiliation(s)
- Dinesh R Pai
- Penn State Harrisburg, School of Business Administration, Middletown, Pennsylvania, USA
| | | | - Anna M Anna
- Rural Health Redesign Center Organization, Harrisburg, Pennsylvania, USA
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Abid M, Schneider AB. Clinical Informatics and the Electronic Medical Record. Surg Clin North Am 2023; 103:247-258. [PMID: 36948716 DOI: 10.1016/j.suc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The electronic medical record has fundamentally altered the way surgeons participate and practice medicine. There is now a wealth of data, once hidden behind paper records, that is, now available to surgeons to provide superior care to their patients. This article reviews the history of the electronic medical record, discusses use cases of additional data resources, and highlights the pitfalls of this relatively new technology.
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Affiliation(s)
- Mustafa Abid
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Andrew B Schneider
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA.
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Szetela P, Kostrzewska O, Siegrist Jr RB, Quentin W. The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review. Int J Health Policy Manag 2022; 11:2816-2828. [PMID: 35988029 PMCID: PMC10105205 DOI: 10.34172/ijhpm.2022.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Szetela
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Olga Kostrzewska
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium
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Modi S, Feldman SS. The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review. JMIR Med Inform 2022; 10:e37283. [PMID: 36166286 PMCID: PMC9555331 DOI: 10.2196/37283] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health records (EHRs) are the electronic records of patient health information created during ≥1 encounter in any health care setting. The Health Information Technology Act of 2009 has been a major driver of the adoption and implementation of EHRs in the United States. Given that the adoption of EHRs is a complex and expensive investment, a return on this investment is expected. Objective This literature review aims to focus on how the value of EHRs as an intervention is defined in relation to the elaboration of value into 2 different value outcome categories, financial and clinical outcomes, and to understand how EHRs contribute to these 2 value outcome categories. Methods This literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The initial search of key terms, EHRs, values, financial outcomes, and clinical outcomes in 3 different databases yielded 971 articles, of which, after removing 410 (42.2%) duplicates, 561 (57.8%) were incorporated in the title and abstract screening. During the title and abstract screening phase, articles were excluded from further review phases if they met any of the following criteria: not relevant to the outcomes of interest, not relevant to EHRs, nonempirical, and non–peer reviewed. After the application of the exclusion criteria, 80 studies remained for a full-text review. After evaluating the full text of the residual 80 studies, 26 (33%) studies were excluded as they did not address the impact of EHR adoption on the outcomes of interest. Furthermore, 4 additional studies were discovered through manual reference searches and were added to the total, resulting in 58 studies for analysis. A qualitative analysis tool, ATLAS.ti. (version 8.2), was used to categorize and code the final 58 studies. Results The findings from the literature review indicated a combination of positive and negative impacts of EHRs on financial and clinical outcomes. Of the 58 studies surveyed for this review of the literature, 5 (9%) reported on the intersection of financial and clinical outcomes. To investigate this intersection further, the category “Value–Intersection of Financial and Clinical Outcomes” was generated. Approximately 80% (4/5) of these studies specified a positive association between EHR adoption and financial and clinical outcomes. Conclusions This review of the literature reports on the individual and collective value of EHRs from a financial and clinical outcomes perspective. The collective perspective examined the intersection of financial and clinical outcomes, suggesting a reversal of the current understanding of how IT investments could generate improvements in productivity, and prompted a new question to be asked about whether an increase in productivity could potentially lead to more IT investments.
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Affiliation(s)
- Shikha Modi
- Department of Political Science, Auburn University, Auburn, AL, United States
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
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Beauvais B, Kruse CS, Fulton L, Shanmugam R, Ramamonjiarivelo Z, Brooks M. Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis. J Med Internet Res 2021; 23:e23961. [PMID: 33851924 PMCID: PMC8082376 DOI: 10.2196/23961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/30/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. Objective In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. Methods This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value–Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. Results None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; β=−.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%). Conclusions The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.
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Affiliation(s)
- Bradley Beauvais
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Clemens Scott Kruse
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Lawrence Fulton
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Ramalingam Shanmugam
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Zo Ramamonjiarivelo
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Matthew Brooks
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
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Ruiz-Mallorquí MV, Aguiar-Díaz I, González- López Valcárcel B. Arrangements with the NHS for providing healthcare services: do they improve financial performance of private for-profit hospitals in Spain? HEALTH ECONOMICS REVIEW 2021; 11:9. [PMID: 33689038 PMCID: PMC7944633 DOI: 10.1186/s13561-021-00304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.
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Affiliation(s)
- María Victoria Ruiz-Mallorquí
- Department of Financial Economy and Accounting, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
| | - Inmaculada Aguiar-Díaz
- Department of Financial Economy and Accounting, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
| | - Beatriz González- López Valcárcel
- Department of Quantitative Methods for Economics and Management, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
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Murphy ZR, Wang J, Boland MV. Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes. JAMA Netw Open 2020; 3:e2012529. [PMID: 32902649 PMCID: PMC7489820 DOI: 10.1001/jamanetworkopen.2020.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE By 2018, Medicare spent more than $30 billion to incentivize the adoption of electronic health records (EHRs), based partially on the belief that EHRs would improve health care quality and safety. In a time when most hospitals are well past minimum meaningful use (MU) requirements, examining whether EHR implementation beyond the minimum threshold is associated with increased quality and safety may guide the future focus of EHR development and incentive structures. OBJECTIVE To determine whether EHR implementation above MU performance thresholds is associated with changes in hospital patient satisfaction, efficiency, and safety. DESIGN, SETTING, AND PARTICIPANTS This quantile regression analysis of cross-sectional data used publicly available data sets from 2362 acute care hospitals in the United States participating in both the MU and Hospital Value-Based Purchasing (HVBP) programs from January 1 to December 31, 2016. Data were analyzed from August 1, 2019, to May 22, 2020. EXPOSURES Seven MU program performance measures, including medication and laboratory orders placed through the EHR, online health information availability and access rates, medication reconciliation through the EHR, patient-specific educational resources, and electronic health information exchange. MAIN OUTCOMES AND MEASURES The HVBP outcomes included patient satisfaction survey dimensions, Medicare spending per beneficiary, and 5 types of hospital-acquired infections. RESULTS Among the 2362 participating hospitals, mixed associations were found between MU measures and HVBP outcomes, all varying by outcome quantile and in some cases by interaction with EHR vendor. Computerized provider order entry (CPOE) for laboratory orders was associated with decreased ratings of every patient satisfaction outcome at middle quantiles (communication with nurses: β = -0.33 [P = .04]; communication with physicians: β = -0.50 [P < .001]; responsiveness of hospital staff: β = -0.57 [P = .03]; care transition performance: β = -0.66 [P < .001]; communication about medicines: β = -0.52 [P = .002]; cleanliness and quietness: β = -0.58 [P = .007]; discharge information: β = -0.48 [P < .001]; and overall rating: β = -0.95 [P < .001]). However, at middle quantiles, CPOE for medication orders was associated with increased ratings for communication with physicians (τ = 0.5; β = 0.54; P = .009), care transition (τ = 0.5; β = 1.24; P < .001), discharge information (τ = 0.5; β = 0.41; P = .01), and overall hospital ratings (τ = 0.5; β = 0.97; P = .02). At high quantiles, electronic health information exchange was associated with improved ratings of communication with nurses (τ = 0.9; β = 0.23; P = .03). Medication reconciliation had positive associations with increased communication with nursing at low quantiles (τ = 0.1; β = 0.60; P < .001), increased discharge information at middle quantiles (τ = 0.5; β = 0.28; P = .03), and responsiveness of hospital staff at middle (τ = 0.5; β = 0.77; P = .001) and high (τ = 0.9; β = 0.84; P = .001) quantiles. Patients accessing their health information online was not associated with any outcomes. Increased use of patient-specific educational resources identified through the EHR was associated with increased ratings of communication with physicians at high quantiles (τ = 0.9; β = 0.20; P = .02) and with decreased spending at low-spending hospitals (τ = 0.1; β = -0.40; P = .008). CONCLUSIONS AND RELEVANCE Increasing EHR implementation, as measured by MU criteria, was not straightforwardly associated with increased HVBP measures of patient satisfaction, spending, and safety in this study. These results call for a critical evaluation of the criteria by which EHR implementation is measured and increased attention to how different EHR products may lead to differential outcomes.
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Affiliation(s)
- Zachary R Murphy
- currently a medical student at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zhao M, Hamadi H, Rob Haley D, White-Williams C, Liu X, Spaulding A. The Relationship between Health Information Technology Laboratory Tracking Systems and Hospital Financial Performance and Quality. Hosp Top 2019; 97:99-106. [PMID: 31166151 DOI: 10.1080/00185868.2019.1623735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.
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Affiliation(s)
- Mei Zhao
- a Department of Health Administration, Brooks College of Health , University of North Florida , Jacksonville , FL , USA
| | - Hanadi Hamadi
- a Department of Health Administration, Brooks College of Health , University of North Florida , Jacksonville , FL , USA
| | - D Rob Haley
- b Master of Health Administration Program , Brooks College of Health, University of North Florida , Jacksonville , FL , USA
| | - Cynthia White-Williams
- a Department of Health Administration, Brooks College of Health , University of North Florida , Jacksonville , FL , USA
| | - Xinliang Liu
- c Department of Health Management and Informatics , University of Central Florida , Orlando, FL, USA
| | - Aaron Spaulding
- d Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery , Jacksonville, FL, USA
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14
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Abstract
Limited research exists which aids in structuring health IT contracts in an era of performance-based payments. We provide an assessment of common approaches to contracting and measuring of performance in practice. We conducted a review of existing literature and compliment this approach with a survey of healthcare professionals directly involved with health IT systems to further understand and classify current approaches. We identified architypes for structuring healthcare IT performance contracts to include: (1) internal operations, (2) external evaluation and (3) joint agreement for the delivery of value-based care.
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Affiliation(s)
- Thomas R Martin
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
| | - Hamlet Gasoyan
- b Department of Health Services Administration and Policy , College of Public Health, Temple University , Philadelphia , PA , USA
| | - David J Wierz
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
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15
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Impact of electronic medical records (EMRs) on hospital productivity in Japan. Int J Med Inform 2018; 118:36-43. [DOI: 10.1016/j.ijmedinf.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
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Al-Rawajfah O, Tubaishat A. Barriers and facilitators to using electronic healthcare records in Jordanian hospitals from the nurses' perspective: A national survey. Inform Health Soc Care 2017; 44:1-11. [PMID: 28829654 DOI: 10.1080/17538157.2017.1353998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Jordan is currently taking significant steps to implement electronic healthcare records (EHRs) in hospitals. PURPOSE To explore Jordanian nurses' views on the factors which act as barriers or facilitators to implementing EHRs in the country's hospitals. METHODS A descriptive, cross-sectional design was used to obtain a sample of nurses working in Jordanian hospitals. The study utilized a tool used by the American Hospital Association. RESULTS The final sample consisted of 2,793 nurses from 26 hospitals. 62.4% of these were working in governmental hospitals, 58.9% were female, and the mean age of the nurses was 30.3 years (SD = 6.2). Incentives to purchase EHRs, the availability of technical assistance, and additional reimbursement for the use of EHRs were the most common facilitating factors identified, while the economic burden of purchasing EHRs, a lack of information technology staff, and disruption to clinical care were the most common barriers. CONCLUSION Future projects for implementing EHR systems in Jordan should consider the facilitators and barriers identified.
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Affiliation(s)
- Omar Al-Rawajfah
- a Department of Adult Health and Critical Care , Sultan Qaboos University College of Nursing , Muscat , Oman
| | - Ahmad Tubaishat
- b Faculty of Nursing , AL AL-Bayt University, Adult Health Nursing , Mafraq , Jordan
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Castlen JP, Cote DJ, Moojen WA, Robe PA, Balak N, Brennum J, Ammirati M, Mathiesen T, Broekman ML. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice. World Neurosurg 2017; 102:420-424. [DOI: 10.1016/j.wneu.2017.03.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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