Jonathan R Enriquez1, James A de Lemos2, Shailja V Parikh2, DaJuanicia N Simon2, Laine E Thomas2, Tracy Y Wang2, Paul S Chan2, John A Spertus2, Sandeep R Das2. 1. From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.). enriquezj@umkc.edu. 2. From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
Abstract
BACKGROUND: In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. CONCLUSIONS: EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen.
BACKGROUND: In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparinoverdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. CONCLUSIONS: EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparinoverdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen.
Authors: Elizabeth H Bradley; Jeph Herrin; Brian Elbel; Robert L McNamara; David J Magid; Brahmajee K Nallamothu; Yongfei Wang; Sharon-Lise T Normand; John A Spertus; Harlan M Krumholz Journal: JAMA Date: 2006-07-05 Impact factor: 56.272
Authors: Karen E Joynt; Deepak L Bhatt; Lee H Schwamm; Ying Xian; Paul A Heidenreich; Gregg C Fonarow; Eric E Smith; Megan L Neely; Maria V Grau-Sepulveda; Adrian F Hernandez Journal: J Am Coll Cardiol Date: 2015-05-12 Impact factor: 24.094
Authors: Ashly D Black; Josip Car; Claudia Pagliari; Chantelle Anandan; Kathrin Cresswell; Tomislav Bokun; Brian McKinstry; Rob Procter; Azeem Majeed; Aziz Sheikh Journal: PLoS Med Date: 2011-01-18 Impact factor: 11.069
Authors: Andrew Frazer; James Rowland; Alison Mudge; Michael Barras; Jennifer Martin; Peter Donovan Journal: Eur J Clin Pharmacol Date: 2019-09-11 Impact factor: 2.953
Authors: Jörg C Brokmann; Rolf Rossaint; Michael Müller; Christina Fitzner; Luigi Villa; Stefan K Beckers; Sebastian Bergrath Journal: J Clin Hypertens (Greenwich) Date: 2017-05-30 Impact factor: 3.738
Authors: Min Zhao; Kerstin Klipstein-Grobusch; Xin Wang; Johannes B Reitsma; Dong Zhao; Diederick E Grobbee; Ian Graham; Ilonca Vaartjes Journal: PLoS One Date: 2017-04-20 Impact factor: 3.240