Electronic Health Records:

Are they saving lives?

A recent New York Times article cast the innovation of electronic health records (EHRs) in a surprising light, suggesting that their use and adoption might be creating many problems similar to the very issues they are meant to mitigate. The conventional wisdom indicates that EHRs save lives by reducing clinical errors. This article, which cites mostly anecdotal data, suggests that the newer tools used by medical staff create some of the same problems by being difficult to use. There is a study underway to determine these hazards, if they exist.

The following analysis examines the relationship between EHR adoption (as quantified at the state level by hosptial participation in the Medicare Medicaid EHR Incentive Plan) and the incidence of infant death as reported by the Centers for Disease Control in the years 2008 (prior to the plan's inception) and 2011 (most recent year for which mortality data was available), seeking to establish whether EHRs had a positive or negative effect on this phenomenon.

About the Medicare Medicaid EHR incentive plan: "The EHR Incentive Programs, which began in 2011, provide incentive payments to eligible professionals, hospitals, and critical access hospitals as they adopt, implement, upgrade, or meaningfully use certified EHR technology in ways that improve care...The program was established by the Health Information for Clinical and Economic Health Act of 2009 (HITECH), one of President Obama’s first priorities enacted upon taking office."

"…The Medicare and Medicaid EHR Incentive Programs provide incentive payments for using EHR technology in ‘meaningful’ ways that lead to higher quality care, improved patient safety, and shared decision making by patients and physicians. Under both the Medicare and Medicaid EHR Incentive Programs, eligible hospitals and critical access hospitals can receive support and financial incentives or implementing and meaningfully using certified EHR technology."

data source on EHR Incentive Plan participation: the Centers for Medicare & Medicaid Services

data source on infant deaths: Centers for Disease Control and Prevention see also: 1, 2, 3

The left side of the chart below compares the participation rate across the states in the Medicare/Medicaid EHR Incentive Plan by number of participating hospitals per 1 million residents. The right side of the chart illustrates the change in infant death rates from 2008-2011. Where there was an increase, the line is rendered in red. There was an average reduction of 14.9%, and in most cases an increase was seen where there were fewer than the average number of hospitals participating in the incentive plan. The most impressive reductions, however, were not necessarily correlated with greater numbers of participating hospitals.

 

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map 1: States ranked by hospitals participating in EHR incentive plan

map 2: States ranked by reduction in infant death rates

Scatter plot and histogram:

The scatterplot shows that there is some small correlation between the presence of participating hospitals in a state with an improvement in infant death rates, but the improvement does not necessarily grow with an increase in hospitals above the average.

The histogram shows that the most common percentage of reduction in infant death was between 19% and 24%

Bar chart


Conclusions?

The program is very new and more detailed and current mortality data will be required to draw more nuanced conclusions about the program's success. For the present the evidence is encouraging: it would seem that there may be a correlation, albeit a weak one, between an increase in EHR adoption and a decrease in infant death rates.