Business Benefits or Incentive Maximization? Impacts of the Medicare EHR Incentive Program at Acute Care Hospitals

Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study

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.

The Value of Electronic Health Records Since the Health Information Technology for Economic and Clinical Health Act: Systematic Review

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.

A Data Driven Multi-Layer Framework of Pervasive Information Computing System for eHealthcare

In the last decade, significant advancements in telecommunications and informatics have seen which incredibly boost mobile communications, wireless networks, and pervasive computing. It enables healthcare applications to increase human livelihood. Furthermore, it seems feasible to continuous observation of patients and elderly individuals for their wellbeing. Such pervasive arrangements enable medical experts to analyse current patient status, minimise reaction time, increase livelihood, scalability, and availability. There is found plenty of remote patient monitoring model in literature, and most of them are designed with limited scope. Most of them are lacking to give an overall unified, complete model which talk about all state-of-the-art functionalities. In this regard, remote patient monitoring systems (RPMS's) play important roles through wearable devices to monitor the patient's physiological condition. RPMS also enables the capture of related videos, images, and frames. RPMS do not mean to enable only capturing various sorts of patient-related information, but it also must facilitate analytics, transformation, security, alerts, accessibility, etc. In this view, RPMS must ensure some broad issues like, wearability, adaptability, interoperability, integration, security, and network efficiency. This article proposes a data-driven multi-layer architecture for pervasively remote patient monitoring that incorporates these issues. The system has been classified into five fundamental layers: the data acquisition layer, the data pre-processing layer, the network and data transfer layer, the data management layer and the data accessing layer. It enables patient care at real-time using the network infrastructure efficiently. A detailed discussion on various security issues have been carried out. Moreover, standard deviation-based data reduction and a machine-learning-based data access policy is also proposed.

An Intelligent Multi-Objective Framework of Pervasive Information Computing

This article describes how electronic healthcare has been the key application of pervasive computing innovations to enhance healthcare quality and protect human lives. Specific patients of constant sicknesses and elderly individuals, by and large, may oblige continuous observing of their wellbeing status wherever they are. In this regard, remote patient monitoring technology plays the various important role through wearable devices to monitor patient's physiological figures. But, this must ensure some broad issues like, wearability, adaptability, interoperability, integration, security, and network efficiency. This article proposes a data-driven multi-layer architecture for pervasively remote patient monitoring that incorporates aforesaid issues. It enables the patient's care at the real time and supports anywhere and anytime requirement with using network infrastructure efficiently.