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• Health Information Technologies Equal Better Outcomes
Health Information Technologies Equal Better Outcomes
Patients at Texas hospitals that have automated notes and records, order entry and clinical decision support of their health information systems have fewer complications, lower death rates and reduced costs, according to a report in the January 26 issue of Archives of Internal Medicine.
“This study is extremely relevant as the new administration in Washington considers how health information technology investments by the Federal government can improve health outcomes and ultimately the health status of our nation,” said Camille D. Miller , President / CEO of Texas Health Institute, a health policy think-tank based in Austin, Texas. “The study’s results suggest that 100,000 lives nationally would be saved each year if all hospitals achieved the highest level of computerization for health notes and records.”
Dr. Ruben Amarasingham , M.D., M.B.A., of Parkland Health & Hospital System and University of Texas Southwestern Medical Center, Dallas, is the lead author of the study and a former THI ‘Institute Scholar’. Amarasingham and colleagues compared urban hospitals in Texas, measuring physician interaction with clinical information systems and the rates of inpatient death, complications, costs and length of stay. Their conclusions hold far greater potential impacts upon health care systems in the future.
“One could speculate that electronic systems will allow far greater disease surveillance, targeted public health programming, and shifts to prevention using predictive modeling and real-time monitoring,” said Amarasingham in an interview with THI.
As for the study itself, Amarasingham says, “I think there are two large lessons: 1) successfully implemented clinical information systems could yield significant clinical and financial benefits; 2) successful implementation requires early and intense engagement with physicians and other health professionals and a commitment to building an environment in which the technology, processes, people, and culture of the institution are self-reinforcing.”
Although clinical information technology studies have previously indicated similar results in single hospital settings, including reduced complications and mortality rates, few studies have included multiple hospital systems.
Focusing on a diverse group of Texas hospitals, this study reviewed the link between the hospitals’ use of clinical information technology associated with notes, records, test results, order entry and decision support and the relationship to inpatient mortality, complications, costs and length of stay for four specific medical conditions. From the four conditions studied, coronary artery bypass grafting, congestive heart failure, myocardial infarction and pneumonia, greater uses of information technology resulted in decreased adjusted odds ratios for fatal hospitalizations.
Also noted in the clinical information technologies study:
• 9% decrease in the adjusted odds of death from myocardial infarction with the use of advanced order entry capability.
• 55% decrease in the adjusted odds of death from coronary artery bypass graft procedures with the use of advanced order entry capability.
• 15% decrease in the adjusted odds of death from each of the four study conditions when notes and records are automated.
• 16% decrease in the adjusted odds of complications for each of the four study conditions when decision support was applied.
• Lower hospitalization costs for nearly all clinical conditions were noted when test results (-$110), order entry (-$132) and decision support (- $538) were automated.
Reacting to the results of the study, Dr. Dan Stultz , M.D., FACP, FACHE and President/CEO of the Texas Hospital Association (THA) said, “Health information technology has the potential to save lives, improve care, and improve efficiency in our health system. While use of it will not solve every health care problem, its potential benefits are substantial, justifying government action to realize them. In particular, financial incentives may be necessary to accelerate the move to new technologies.”
The health information technology study results are of particular concern for rural hospitals operating with limited resources. “This study provides the basis to support increased automation and the adoption of proven and appropriate technologies that improve patient outcomes for all hospitals. Rural and small hospitals are often under resourced and may lack both the funding and the staff necessary to make such improvements,” said David Pearson , President / CEO of Texas Organization of Rural & Community Hospitals (TORCH). “It is our hope that the state and federal governments will consider this evidence and help our facilities to be able to make these investments for the benefit of the patients we serve.”
"Given a better tool in which to support care decisions, it is no surprise that care will improve,” said Dr. Josie Williams , MD, president of the Texas Medical Association, which provided some logistical support to this research. “Physicians and other providers want to practice the best possible medicine. Information technology is and will be a powerful tool when it is interchangeable, functional, and affordable to all health care providers.”
The study was funded by the Commonwealth Fund in New York City.
Full study text is available at: Archives of Internal Medicine
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