Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide
Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide
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DOI：
10.1093/jamia/ocx080
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发表时间：
2017-11-01
影响因子：
6.4
通讯作者：
Patel, Vaishali
中科院分区：
文献类型：
--
作者：
Adler-Milstein, Julia;Holmgren, A. Jay;Patel, Vaishali
虽然大多数医院已经采用了电子健康记录(EHR)，但我们对医院是否以对改善结果至关重要的高级方式使用EHR知之甚少，以及资源较少的医院--小型、农村、安全网--是否跟上了电子健康记录的步伐。我们使用2008-2015年美国医院协会信息技术补充调查数据，衡量了医院对电子健康记录的“基本”和“全面”采用情况，以提供最新的全国数据。然后，我们使用新的补充问题来评估EHR和EHR数据在绩效测量和患者参与功能方面的高级使用情况。为了评估数字“高级使用”的差距，我们运行Logistic回归模型来确定与每个高级使用领域的高采用率相关的医院特征。我们发现，80.5%的医院至少采用了基本的EHR系统，比2014年增加了5.3个百分点。只有37.5%的医院采用了至少8个(10个)EHR数据作为绩效衡量功能，41.7%的医院采用了至少8个(10个)患者参与功能。关键准入医院不太可能采用至少8项绩效衡量功能(优势比[OR]=0.58；P<；.001)和至少8项患者参与功能(OR=0.68；P=0.02)。虽然《经济和临床卫生信息技术法案》导致医院广泛采用电子病历，但高级电子病历功能的使用滞后，数字鸿沟似乎正在出现，尤其是关键准入医院落后。这是令人担忧的，因为启用EHR的绩效衡量和患者参与度是提高医院绩效的关键因素。医院EHR的采用非常普遍，许多医院正在使用EHR来支持绩效衡量和患者参与度。然而，这并不是所有医院都会发生的事情。
While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources - small, rural, safety-net - are keeping up.Using 2008-2015 American Hospital Association Information Technology Supplement survey data, we measured "basic" and "comprehensive" EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital "advanced use" divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain.We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P < .001) and at least 8 patient engagement functions (OR = 0.68; P = 0.02).While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance.Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals.