January 30, 2009
Wired Hospitals Post Lower Death, Complication Rates
The more "wired" a hospital is, the lower its rate of patient deaths and complications, according to a new study published in the Archives of Internal Medicine. The authors point out that "despite speculation that clinical information technologies will improve clinical and financial outcomes, few studies have examined this relationship in a large number of hospitals."
The study was a 6-month, cross-sectional study of 41 urban hospitals in Texas using the Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on physician interactions with the information system
Results showed that for all medical conditions studied, a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations. Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively. For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications. Higher scores on test results, order entry, and decision support were associated with lower costs for all hospital admissions.
The researchers concluded that a study such as this "provides empirical evidence that greater automation of a hospital's information system may be associated with reductions in mortality, complications, and costs. Higher decision support scores were associated with statistically significant reductions in the odds of complications among all causes and for myocardial infarction specifically, and with reductions in the odds of death for pneumonia. Among the remaining associations that were not statistically significant, all showed trends toward reductions in mortality and complications. 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. Knowledge aids provided in this fashion could reduce the risk of complications and possibly death, providing a theoretical basis for the association we observed."
It was also noted that" despite these strengths, this study has important limitations. First, the design does not consider a number of organizational confounders that could explain superior clinical outcomes, most notably a hospital's emphasis on safety and quality. Hospitals that do not emphasize a culture of safety or encourage continuous improvement are probably incapable of replicating the type of sociotechnical environment that would produce a high score in this study. In this sense, the distinction between whether a hospital's superior outcomes are because of its emphasis on quality or its investment in clinical information technologies becomes less meaningful because both are likely required to produce a high-functioning sociotechnical environment. Future studies using mixed or qualitative methods at several representative sites may help clarify these relationships.
The authors believe that clinical information technologies hold great promise as a tool to improve hospital medicine. For certain conditions, greater automation of a hospital's information system may be associated with reductions in mortality, complications, and costs, suggesting that information technologies that are properly designed and executed around clinical workflows could meet that promise.
Clinical Information Technologies and Inpatient Outcomes
Archives of Internal Medicine (Full Text)