Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 6;7(1):21.
doi: 10.5334/egems.269.

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation

Tiago K Colicchio  1 , Damian Borbolla  2 , Vanessa D Colicchio  2 , Debra L Scammon  2 , Guilherme Del Fiol  2 , Julio C Facelli  2 , Watson A Bowes 3rd  2   3 , Scott P Narus  2   3
Affiliations

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation

Tiago K Colicchio et al. EGEMS (Wash DC). .

Abstract

Objective: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research.

Methods: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation. Fourteen interviews were recorded and transcribed. Three authors independently coded interview narratives and via consensus identified factors contributing to changes on 15 outcomes of quality, productivity, and safety.

Results: We identified 14 factors that potentially affected the outcomes previously monitored. Our findings demonstrate that several factors related to the implementation (e.g., incomplete data migration), partially related (e.g., intentional decrease in volume of work), and not related (e.g., health insurance changes) may affect outcomes in different ways.

Discussion: This is the first study to investigate factors contributing to changes on a broad set of quality, productivity, and safety outcomes during an EHR implementation guided by the results of a large longitudinal evaluation. The diversity of factors identified indicates that the need for organizational adaptation to take full advantage of new technologies is as important for health care as it is for other services sectors.

Conclusions: We recommend continuous identification and monitoring of these factors in future evaluations to hopefully increase our understanding of the full impact of health information technology interventions.

Keywords: Adoption; Electronic Health Records; Medical Informatics Applications; Mixed-method; Outcome Assessment.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Example graph illustrating monthly length of stay in the ED with a significant increase at the intervention hospital immediately after the go live followed by recovery to the baseline within 12 months.
See this image and copyright information in PMC

References

    1. Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008–2015 [Internet]. [cited 2017 October 10]. Available from: https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute....
    1. Jones, SS, Rudin, RS, Perry, T and Shekelle, PG. Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use. Ann Intern Med. 2014. January 7; 160(1): 48–54. DOI: 10.7326/M13-1531 - DOI - PubMed
    1. Koppel, R. Is Healthcare Information Technology Based on Evidence? Yearb Med Inform. 2013; 7–12. DOI: 10.1055/s-0038-1638826 - DOI - PubMed
    1. Rudin, RS, Jones, SS, Shekelle, P, Hillestad, RJ and Keeler, EB. The value of health information technology: filling the knowledge gap. Am J Manag Care. 2014. November; 20(11 Spec No. 17): eSP1–8. - PubMed
    1. Brynjolfsson, E and Hitt, LM. Beyond the productivity paradox. Communications of the ACM. 1998; 41(8): 49–55. DOI: 10.1145/280324.280332 - DOI

LinkOut - more resources