title: Adverse inpatient outcomes during the transition to a new electronic health record system: observational study.
abstract: OBJECTIVE
  To assess the short term association of inpatient implementation of electronic health records (EHRs) with patient outcomes of mortality, readmissions, and adverse safety events.
  
  
  METHODS
  Observational study with difference-in-differences analysis.
  
  
  METHODS
  Medicare, 2011-12.
  
  
  METHODS
  Patients admitted to 17 study hospitals with a verifiable "go live" date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region.
  
  
  METHODS
  All cause readmission within 30 days of discharge, all cause mortality within 30 days of admission, and adverse safety events as defined by the patient safety for selected indicators (PSI)-90 composite measure among Medicare beneficiaries admitted to one of these hospitals 90 days before and 90 days after implementation of the EHRs (n=28 235 and 26 453 admissions), compared with the control group of all contemporaneous admissions to hospitals in the same hospital referral region (n=284 632 and 276 513 admissions). Analyses were adjusted for beneficiaries' sociodemographic and clinical characteristics.
  
  
  RESULTS
  Before and after implementation, characteristics of admissions were similar in both study and control hospitals. Among study hospitals, unadjusted 30 day mortality (6.74% to 7.15%, P=0.06) and adverse safety event rates (10.5 to 11.4 events per 1000 admissions, P=0.34) did not significantly change after implementation of EHRs. There was an unadjusted decrease in 30 day readmission rates, from 19.9% to 19.0% post-implementation (P=0.02). In difference-in-differences analysis, however, there was no significant change in any outcome between pre-implementation and post-implementation periods (all P≥0.13).
  
  
  CONCLUSIONS
  Despite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short term inpatient mortality, adverse safety events, or readmissions in the Medicare population across 17 US hospitals.
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Barnett
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Massachusetts General Hospital, Boston, MA, USA jena@hcp.med.harvard.edu.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006284:Health Plan Implementation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D010359:Patient Readmission; D010360:Patient Transfer / Q000706:statistics & numerical data*; D014481:United States