title: Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke.
abstract: OBJECTIVE
  Electronic health record systems with computerized physician order entry and condition-specific order sets are intended to standardize patient management and minimize errors of omission. However, the effect of these systems on disease-specific process measures and patient outcomes is not well established. We seek to evaluate the effect of computerized physician order entry electronic health record implementation on process measures and short-term health outcomes for patients hospitalized with acute ischemic stroke.
  
  
  METHODS
  We conducted a quasi-experimental cohort study of patients hospitalized for acute ischemic stroke with concurrent controls that took advantage of the staggered implementation of a comprehensive computerized physician order entry electronic health record across 16 medical centers within an integrated health care delivery system from 2007 to 2012. The study population included all patients admitted to the hospital from the emergency department (ED) for acute ischemic stroke, with an initial neuroimaging study within 2.5 hours of ED arrival. We evaluated the association between the availability of a computerized physician order entry electronic health record and the rates of ED intravenous tissue plasminogen activator administration, hospital-acquired pneumonia, and inhospital and 90-day mortality, using doubly robust estimation models to adjust for demographics, comorbidities, secular trends, and concurrent primary stroke center certification status at each center.
  
  
  RESULTS
  Of 10,081 eligible patients, 6,686 (66.3%) were treated in centers after the computerized physician order entry electronic health record had been implemented. Computerized physician order entry was associated with significantly higher rates of intravenous tissue plasminogen activator administration (rate difference 3.4%; 95% confidence interval 0.8% to 6.0%) but not with significant rate differences in pneumonia or mortality.
  
  
  CONCLUSIONS
  For patients hospitalized for acute ischemic stroke, computerized physician order entry use was associated with increased use of intravenous tissue plasminogen activator.
authors.affiliation: Kaiser Permanente San Rafael Medical Center, San Rafael, CA; Kaiser Permanente Division of Research, Oakland, CA. Electronic address: dustin.ballard@kp.org.
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
authors.affiliation: Department of Neurology, University of California at San Francisco, San Francisco, CA.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.affiliation: Kaiser Permanente San Leandro Medical Center, San Leandro, CA.
authors.forename: David K
authors.initials: DK
authors.lastname: Park
authors.affiliation: Kaiser Permanente San Leandro Medical Center, San Leandro, CA.
authors.forename: Mamata V
authors.initials: MV
authors.lastname: Kene
authors.affiliation: Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA.
authors.forename: Uli K
authors.initials: UK
authors.lastname: Chettipally
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Hilary R
authors.initials: HR
authors.lastname: Iskin
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA; Kaiser Permanente Roseville Medical Center, Roseville, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.affiliation: Kaiser Permanente Oakland Medical Center, Oakland, CA.
authors.forename: Dustin G
authors.initials: DG
authors.lastname: Mark
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reed
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000453:epidemiology; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D058996:Quality Improvement; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator