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Increased automation of hospital information systems associated with lower costs, mortality
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Hospitals that use automated clinical information technologies in some cases had lower rates of mortality, fewer complications and lower costs, study results suggested.
Researchers examined data from 72 urban hospitals, which included information on 167,233 patients aged older than 50 years who were admitted between December 2005 and May 2006. All hospitals were evaluated using a questionnaire-based information technology assessment tool.
The researchers reported that a 10-point increase in the score for automated notes and records was associated with a 15% decrease in the adjusted odds of inpatient mortality in all-cause hospitalizations (OR=0.85; 95% CI, 0.74-0.97). Hospitals with higher order entry scores were associated with decreased adjusted odds for fatal hospitalizations for patients with MI (OR=0.91; 95% CI, 0.83-0.99) and CABG procedures (OR=0.45; 95% CI, 0.29-0.68). Although a higher automated decision support score was associated with decreased adjusted odds for complications for all causes (OR=0.84; 95% CI, 0.79-0.90) and for MI (OR=0.63; 95% CI, 0.45-0.87), a higher notes and records score was also associated with increased adjusted odds for complications in patients with HF (OR=1.35; 95% CI, 1.16-1.57).
Higher decision support scores were associated with lower costs for all conditions (OR=–$538; 95% CI, –$704 to –$333) and for CABG (OR=–$1,043; 95% CI, –$1,729 to –$55).
Arch Intern Med. 2009;169:108-114.
This is an important paper that documents what we all believe and hope to be true — better and more efficient information management leads to better and more cost-effective patient care. There are several caveats with this paper, however. How much of the improvement can be ascribed to the information systems used and how much of the difference can be ascribed to the culture of the institution that implemented the enhanced information management? The researchers acknowledge this in their discussion. A care environment emphasizing safety and efficiency will probably be a safer and more efficient place with or without sophisticated information management systems. Furthermore, such dedication to safety and efficiency will make such an institution more likely to implement information technology systems. What we want to know is how much the information system itself independently contributed to the improvement. We cannot know this from the current study, which was cross-sectional in design and neither prospective nor randomized. Only 58% of hospitals even responded. Only inpatient data were available, although we know many chronic conditions are best managed as outpatients.
This is a good, although imperfect study, with results that support the hope that information technology can improve quality and reduce costs. In theory, there should be no difference between theory and practice, but as Yogi Berra said, “in practice there is.” Widespread implementation of clinical information technology has been nightmarishly slow, over budget and disappointing to all. We do not yet even have unique patient identifiers so that patients can reliably and seamlessly pass from one proprietary system to another. Ultimately, this is good information, but we have a long way to go.
– Samuel L. Wann, MD
Cardiology Today Section Editor