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Do EHR Implementations Have Negative Short-Term Effects?

EHR implementations causes few negative short-term effects, which is promising for hospitals looking to perform an EHR overhaul or optimization.

By Sara Heath

A new EHR implementation has little to no short-term effect on patient safety and care outcomes, showing that the anticipated disruptions EHR implementation may not be something for providers to worry about, new research shows.

In a study published in The BMJ, researchers examined the implications of a new EHR implementation at 17 different hospitals. The researchers tested hospital readmissions 30 days following discharge, mortality within 30 days of admission, and adverse safety events.

The researchers hypothesized that EHR implementation would have negative short-term consequences on clinical workflow, provided the large undertaking a technology overhaul is.

“Implementing a new EHR or switching to another is likely one of the most disruptive predictable events a hospital can experience, affecting practically every employee and workflow at a hospital,” the researchers explained.

“In the period immediately after implementation, workflow disruptions created by technologies like electronic order entry can give rise to a wide array of unintended consequences, such as inefficient workarounds, disruptions in continuity of care, and other electronically enabled errors.”

By looking at three clinical quality variables for 90 days before and after the EHR implementation, the researchers were able to see just how great an effect the new technology had on hospital workflow.

The study showed that a new EHR implementation had no measurable effect on 30-day mortality rates or adverse safety events. Thirty-day readmissions reduced from 19.9 percent prior to EHR implementation to 19 percent following implementation.

“That we found no association of EHR implementation with inpatient outcomes might be surprising given the negative impact associated with more routine, less disruptive changes,” the researchers reported.

These results should be good news for providers looking to adopt an EHR, change vendors, or undergo a robust EHR optimization project. While prior research suggests a positive relationship between EHR implementation and long-term clinical outcomes, providers can take solace in seeing that same relationship between EHR implementation and short-term outcomes.

Of course, the researchers wrote, there are some exceptions to their results. Some of the researched hospitals were indeed outliers, showing some negative short-term impacts of their EHR implementation. The researchers also reported anecdotal evidence showing that some EHR implementations may not be smooth transitions.

Many of those hospitals have also made headlines.

In 2014, an Epic EHR implementation at Cambridge University Hospitals (CUH) in the United Kingdom caused some technological and clinical quality issues. According to a report in the Cambridge News, these quality issues prompted CUH CEO Dr. Keith McNeil to issue a formal apology to patients.

“I hope that you can understand that these issues are only temporary and we will be able to offer a much improved service in the future,” Dr. Keith McNeil told the news outlet. “For patients, some of you may have been asked to come back for tests or had operations or clinics rearranged. I want to sincerely apologise for the inconvenience and anxiety this may have caused.”

At other hospitals, large EHR implementations have caused financial turmoil.

Following its Epic EHR implementation, Brigham and Women’s Hospital came $53 million short in its projected $121 million surplus for fiscal year 2015. The Boston-based hospital had initially set aside $47 million for the EHR replacement project, but ended up going over budget by $27 million.

As a result, Brigham and Women’s Hospital laid off 20 employees and got rid of nearly 80 vacant positions.

Although these hospitals may serve as a cautionary tale, the recent research does show promise to hospitals and providers looking to change EHR vendors or overhaul their systems. If hospital leaders outline a thorough implementation or optimization plan, they may be able to avoid some of the snags other hospitals have hit.

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