Evaluation of a systematic methodology to detect in near real-time performance changes during electronic health record system implementations: a longitudinal study.

Introduction. Although Electronic Health Record (EHR) adoption has increased in the U.S., our understanding of how it affects health care organizations is still limited. Current literature has produced mixed-results due to the use of simple, non-standardized measurements and poor research designs. Methods. We propose the use of a systematic methodology that combines measures of quality, productivity and safety processes, tracked over time using an interrupted time-series design with multiple control sites. Results. Our methodology successfully detected performance changes during an EHR implementation on 17 (77%) outcomes, including a significant increase in Emergency Department length of stay immediately after go live by 0.19 hours [95%CI (0.12, 0.27), p<0.001], and an improvement in time to complete radiology tests, which significantly decreased per month by 0.19 minutes [95%CI (-0.26, -0.12), p<0.001]. Conclusion. The proposed methodology was able to detect several changes immediately after an EHR implementation and over time. The method is a promising and robust approach to assessing the impact of EHR implementations on a wide range of health care quality, productivity, and safety care processes.