title: Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke.
abstract: BACKGROUND
  Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke.
  
  
  OBJECTIVE
  The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs.
  
  
  METHODS
  We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest.
  
  
  RESULTS
  A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01).
  
  
  CONCLUSIONS
  In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts. Electronic address: kjoynt@partners.org.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: Palo Alto Veterans Affairs Hospital, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: University of California Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Neely
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D010959:Tissue Plasminogen Activator
keywords: hospital mortality; length of stay; medical order entry systems; outcome assessment (health care); registries