title: EHR Adoption and Hospital Performance: Time-Related Effects.
abstract: OBJECTIVE
  To assess whether, 5 years into the HITECH programs, national data reflect a consistent relationship between EHR adoption and hospital outcomes across three important dimensions of hospital performance.
  
  
  METHODS
  Secondary data from the American Hospital Association and CMS (Hospital Compare and EHR Incentive Programs) for nonfederal, acute-care hospitals (2009-2012).
  
  
  METHODS
  We examined the relationship between EHR adoption and three hospital outcomes (process adherence, patient satisfaction, efficiency) using ordinary least squares models with hospital fixed effects. Time-related effects were assessed through comparing the impact of EHR adoption pre (2008/2009) versus post (2010/2011) meaningful use and by meaningful use attestation cohort (2011, 2012, 2013, Never). We used a continuous measure of hospital EHR adoption based on the proportion of electronic functions implemented.
  
  
  METHODS
  We created a panel dataset with hospital-year observations.
  
  
  RESULTS
  Higher levels of EHR adoption were associated with better performance on process adherence (0.147; p < .001) and patient satisfaction (0.118; p < .001), but not efficiency (0.01; p = .78). For all three outcomes, there was a stronger, positive relationship between EHR adoption and performance in 2010/2011 compared to 2008/2009. We found mixed results based on meaningful use attestation cohort.
  
  
  CONCLUSIONS
  Performance gains associated with EHR adoption are apparent in more recent years. The large national investment in EHRs appears to be delivering more consistent benefits than indicated by earlier national studies.
authors.affiliation: School of Information and School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
authors.affiliation: School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI.
authors.forename: Jordan
authors.initials: J
authors.lastname: Everson
authors.affiliation: School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI.
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
mesh_terms: D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity; D006801:Humans; D062527:Meaningful Use / Q000706:statistics & numerical data*; D010067:Ownership; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012111:Residence Characteristics; D013997:Time Factors; D014481:United States
keywords: Health care organizations and systems; hospitals; information technology