title: Effect of Electronic Health Record Implementation in Critical Care on Survival and Medication Errors.
abstract: BACKGROUND
  Electronic health records (EHR) with computerized physician order entry have become exceedingly common and government incentives have urged implementation. The purpose of this study was to ascertain the effect of EHR implementation on medical intensive care unit (MICU) mortality, length of stay (LOS), hospital LOS and medication errors.
  
  
  METHODS
  Prospective, observational study from July 2010-June 2011 in MICU at an urban teaching hospital in Atlanta, Georgia of 797 patients admitted to the MICU; 281 patients before the EHR implementation and 516 patients post-EHR implementation.
  
  
  RESULTS
  Compared with the preimplementation period (N = 43 per 281), the mortality risk at 4 months post-EHR implementation (N = 41 per 247) and at 8 months post-EHR implementation (N = 26 per 269) significantly decreased (P < 0.001). In addition, the mean MICU LOS statistically decreased from 4.03 ± 1.06 days pre-EHR to 3.26 ± 1.06 days 4 months post-EHR and to 3.12 ± 1.05 days 8 months post-EHR (P = 0.002). However, the mean hospital LOS was not statistically decreased. Although medication errors increased after implementation (P = 0.002), this was attributable to less severe errors and there was actually a decrease in the number of severe medication errors (both P < 0.001).
  
  
  CONCLUSIONS
  We report a survival benefit following the implementation of EHR with computerized physician order entry in a critical care setting and a concomitant decrease in the number of severe medication errors. Although overall hospital LOS was not shortened, this study proposes that EHR implementation in a busy urban hospital was associated with improved ICU outcomes.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address: jehan2@emory.edu.
authors.forename: Jenny E
authors.initials: JE
authors.lastname: Han
authors.affiliation: Department of Pharmacy and Drug Information, Grady Memorial Hospital, Atlanta, Georgia.
authors.forename: Marina
authors.initials: M
authors.lastname: Rabinovich
authors.affiliation: Department of Pharmacy and Drug Information, Grady Memorial Hospital, Atlanta, Georgia.
authors.forename: Prasad
authors.initials: P
authors.lastname: Abraham
authors.affiliation: Florida State University, Tallahassee, Florida.
authors.forename: Prerna
authors.initials: P
authors.lastname: Satyanarayana
authors.affiliation: Mercer Health Science Center, Mercer University College of Pharmacy, Atlanta, Georgia.
authors.forename: T Vivan
authors.initials: TV
authors.lastname: Liao
authors.affiliation: Division of Pulmonary, WellStar Health System, Atlanta, Georgia.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Udoji
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, Georgia.
authors.forename: George A
authors.initials: GA
authors.lastname: Cotsonis
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Honig
authors.affiliation: Florida State University, Tallahassee, Florida.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D057286:Electronic Health Records; D005260:Female; D005845:Georgia; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D065186:Interrupted Time Series Analysis; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies
keywords: Computerized physician order entry; Electronic health records; Medication error; Quality improvement