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J Patient Saf. 2016 Feb 6. [Epub ahead of print]

Electronic Health Record Adoption and Rates of In-hospital Adverse Events.

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From the *Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services; †Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Department of Health and Human Services Rockville, MD; ‡Department of Biostatistics, Harvard School of Public Health, Boston, MA; and §Qualidigm, Wethersfield, CT and Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine Farmington, CT.



Nationwide initiatives have focused on improving patient safety through greater use of health information technology. We examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients.


We conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System. The sample included patients age 18 and older that were hospitalized for one of 3 conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and postprocedural events. Adverse event rates and patient exposure to a fully electronic EHR were determined through chart abstraction.


Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13.0% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, patient exposure to a fully electronic EHR was associated with 17% to 30% lower odds of any adverse event for cardiovascular (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.72-0.90), pneumonia (OR, 0.70; CI, 0.62-0.80), and surgery (OR, 0.83; CI, 0.72-0.96) patients. The associations of EHR adoption and adverse events varied by event type and by medical condition.


Cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.

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