Abstract

Objective

Little is known regarding variation among electronic health record (EHR) vendors in quality performance. This issue is compounded by selection effects in which high-quality hospitals coalesce to a subset of market leading vendors. We measured hospital performance, stratified by EHR vendor, across 4 quality metrics.

Materials and Methods

We used data on 1272 hospitals in 2018 across 4 quality measures: Leapfrog Computerized Provider Order Entry/EHR Evaluation, Centers for Medicare and Medicaid Services Hospital Compare Star Ratings, Hospital-Acquired Condition (HAC) score, and Hospital Readmission Reduction Program (HRRP) ratio. We examined score distributions and used multivariable regression to evaluate the association between vendor and score, recovering partial R² to assess the proportion of quality variation explained by vendor.

Results

We found significant variation across and within EHR vendors. The largest vendor, vendor A, had the highest mean score on the Leapfrog Computerized Provider Order Entry/EHR Evaluation and HRRP ratio, vendor G had the highest Hospital Compare score, and vendor F had the highest HAC score. In adjusted models, no vendor was significantly associated with higher performance on more than 2 measures. EHR vendor explained between 1.2% (HAC) and 7.6 (HRRP) of the variation in quality performance.

Discussion

No EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice.

Conclusions

Top performance on quality measures can be achieved with any EHR vendor; much of quality performance is driven by the hospital and how it uses the EHR.

中文翻译：

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通过公开报告的质量措施评估医院电子健康记录供应商的表现

摘要

客观的

关于电子健康记录 (EHR) 供应商在质量绩效方面的差异知之甚少。优质医院与市场领先供应商的子集合并的选择效应使这个问题更加复杂。我们通过 4 个质量指标衡量了按 EHR 供应商分层的医院绩效。

材料和方法

我们使用了 2018 年 1272 家医院的 4 项质量指标数据：Leapfrog 计算机化提供者订单输入/EHR 评估、医疗保险和医疗补助服务中心医院比较星级评级、医院获得性状况 (HAC) 评分和医院再入院减少计划 (HRRP)比率。我们检查了分数分布并使用多变量回归来评估供应商和分数之间的关联，恢复部分 R ²以评估供应商解释的质量变化的比例。

结果

我们发现 EHR 供应商之间和内部存在显着差异。最大的供应商，供应商 A，在 Leapfrog 计算机化提供者订单输入/EHR 评估和 HRRP 比率上的平均得分最高，供应商 G 的医院比较得分最高，供应商 F 的 HAC 得分最高。在调整后的模型中，没有供应商与超过 2 项指标的更高绩效显着相关。EHR 供应商解释了质量绩效差异的 1.2% (HAC) 和 7.6 (HRRP)。

讨论

没有 EHR 供应商与所有测量的更高质量相关联，并且 2 个最大的供应商与最高分数无关。EHR 供应商选择只解释了一小部分质量变化。

结论

任何 EHR 供应商都可以在质量测量方面取得最佳表现；大部分质量绩效是由医院及其使用 EHR 的方式驱动的。