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Health IT
associated with better outcomes, lower costs
Newswise — Patients at Texas hospitals that
have automated some aspects of their health
information systems appear to have fewer
complications, lower death rates and reduced
costs, according to a report in the January
26 issue of Archives of Internal Medicine,
one of the JAMA/Archives journals.
“In recent years, American health care has
been criticized as fragmented, expensive,
unsafe and unfair,” the authors write as
background information in the article.
“Clinical or ‘health’ information
technologies, such as electronic medical
records, computerized provider order entry
systems and clinical decision support
systems, have emerged as one antidote,
promising reductions in waste, gains in
communication, improvements in quality and
new accountabilities through automated
performance measurement.”
A hospital’s clinical information system can
be divided into four categories, the authors
note: medical notes and records, test
results, order entry (instructions for the
treatment of patients) and decision support
(programs that assist physicians and other
providers with decision-making tasks).
Ruben Amarasingham, M.D., M.B.A., of
Parkland Health & Hospital System and
University of Texas Southwestern Medical
Center, Dallas, and colleagues compared
urban hospitals in Texas using a tool that
measures physicians’ interactions with the
information system.
Physicians
from 41 hospitals rated their facilities’
automation in each of the four areas in
surveys taken in 2005 and 2006.
The researchers then examined rates of
inpatient death, complications, costs and
length of stay for 167,233 patients older
than 50 who were admitted to these hospitals
for a variety of conditions during the same
timeframe.
For all of the medical conditions studied,
increased automation of notes and records
was associated with a 15-percent decrease in
the odds of in-hospital death.
At hospitals with higher order entry scores,
those with myocardial infarction (heart
attack) had 9 percent lower odds of death
and those undergoing coronary artery bypass
graft had 55 percent lower odds of death.
Patients with all causes of hospitalization
had 16 percent lower odds of developing
complications at hospitals whose decision
support systems were highly automated.
“Higher scores on test results, order entry
and decision support were associated with
lower costs for all hospital admissions
(-$110, -$132 and -$538, respectively),” the
authors write.
“Prior reports have suggested that decision
support helps health care providers manage
large amounts of incoming data, provides
context for decision making in light of
guidelines and may help physicians avoid
‘sins of omission,’ reputed by some authors
to be the largest source of medical errors,”
they continue.
“Knowledge aids provided in this fashion
could reduce the risk of complications and
possibly death, providing a theoretical
basis for the association we observed.”
“Clinical information technologies hold
great promise as a tool to improve hospital
medicine,” they conclude.
“We
found that, for certain conditions, greater
automation of a hospital’s information
system may be associated with reductions in
mortality [death], complications and costs,
suggesting that information technologies
that are properly designed and executed
around clinical workflows could meet that
promise.”
Editorial: Results
Inform Health IT Debate
CHICAGO – “Amarasingham et al found
impressive relationships between the
presence of several technologies and
complication and mortality rates and lower
costs,” writes David W. Bates, M.D., M.Sc.,
of Brigham and Women’s Hospital, Boston, in
an accompanying editorial.
“At the end of the day, does this article
mean that hospitals should now climb on the
health information technology bandwagon? The
data are too circumstantial to answer this
definitively, but they provide another
extremely important set of results,” Dr.
Bates continues.
“More of such analyses should be done, and
they are likely to be helpful in convincing
policy experts including skeptics like those
at the Congressional Budget Office of the
benefits when these technologies are in
routine use. For large- and medium-sized
hospitals, it appears that the time is now.”
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