EMR use in hospitals can increase costs

A study of California hospitals in various stages of implementation found increased care costs and higher staffing needs. Patient outcomes were mixed.

By — Posted May 21, 2010

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Electronic medical records adoption in hospitals, during the first three years of implementation, is often associated with higher nurse staffing needs and higher costs, as well as increased complications for some patients, according to a study by Arizona State University researchers. However, the study also said EMR adoption did decrease mortality for some conditions.

For the study, researchers examined 326 short-term acute-care hospitals in California that adopted EMRs between 1998 and 2007.

Using nurse staffing and patient outcome data from the California Office of Statewide Health Planning and Development, researchers were able to determine that EMR implementation was associated with 6% to 10% higher cost per discharge in medical surgical units. The study also found an increase in registered nurse hours for hospitals with a slightly more advanced EMR.

Researchers said the results were contrary to what they expected.

Results were posted to the website of Health Services Research in advance of its printed publication (link).

The study was funded by the Center for Health Management Research, a program of the American Hospital Assn.'s Health Research and Educational Trust.

Using the EMR adoption model used by the Healthcare Information and Management Systems Society, researchers grouped the hospitals into three categories that represented the level of sophistication in each one's EMR.

Hospitals with stage 1 adoption -- systems that include pharmacy, laboratory and radiology, and a clinical data repository -- a higher rate of patient complications, between 1.4% and 1.7%, was reported during the second and third year of EMR implementation. Total nursing hours also increased by between 13.3% and 14.6%.

Hospitals in stage 2 of implementation -- systems that have nursing documentation and electronic records for medication administration -- had a nursing-hour increase of between 11.2% and 21.6%. Hospitals at this stage saw little impact on patient outcomes.

Those at the highest level of adoption examined for this study, stage 3 -- systems with clinical decision support and computerized order entry -- saw a 16% to 19.4% rise in nursing hours.

Hospital costs per discharge also rose between 5.9% and 10.3% for hospitals with stage 2 and stage 3 implementation. One reason, the authors note, is that there was little evidence that EMRs can reduce lengths of stay in the hospital.

But while stage 3 hospitals had 2.3% to 3% higher rates of complications, mortality rates were 3% to 4.2% lower, according to the study.

The authors say more research is needed on the long-term impact of EMR use in hospitals.

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