Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry.
BACKGROUND
In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear.


RESULTS
Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status.


CONCLUSIONS
EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen.
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.). enriquezj@umkc.edu.
Jonathan R
JR
Enriquez
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
James A
JA
de Lemos
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Shailja V
SV
Parikh
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
DaJuanicia N
DN
Simon
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Laine E
LE
Thomas
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Tracy Y
TY
Wang
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Paul S
PS
Chan
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
John A
JA
Spertus
From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Sandeep R
SR
Das
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D003695:Delivery of Health Care / Q000592:standards; D062787:Drug Overdose / Q000517:prevention & control; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006493:Heparin / Q000009:adverse effects; D006761:Hospitals / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care / Q000592:standards; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants; D006493:Heparin
acute coronary syndrome; electronic health records; myocardial infarction; quality improvement; registries