Digital maturity makes a difference in patient safety and outcomes

Anne Snowdon, chief scientific research officer at HIMSS

Photo: HIMSS TV

Digital maturity matters when it comes to patient safety and outcomes, according to a research paper published by Anne Snowdon, chief scientific research officer at HIMSS.

Using data on 2,000 hospitals nationwide obtained from the nonprofit hospital safety watchdog organization the Leapfrog Group, Snowdon's research shows that hospitals that have obtained Stage 6 or 7 in the Electronic Medical Record Adoption Model (EMRAM) are statistically more likely to have higher quality and safety grades and lower rates of adverse events such as infections, falls and pressure ulcers.

Snowdon compared hospitals that were at a digitally mature EMRAM Stage 6 or 7 to those at Stage zero. Hospitals at the higher stages had a threefold likelihood of a Grade A by Leapfrog.

"As a researcher," Snowdon said, "what I see in the data, it does start to improve at Stages 2 and 3."

However, less than a quarter of the U.S. hospitals studied, 23.5%, are at a Stage 6/7 of digital maturity, while 76.6% of hospitals are at a maturity level of zero.

"Do people really realize that digital maturity matters?" Snowdon said. "It really does. It's quality and safety."

For clinicians, this means an ease of getting information on a patient, in real time, said Snowdon, a nurse by training. This makes a difference not only to patient health, but also to clinician burnout.

The necessity for clinicians to open numerous screens to get information, the often described "death by a thousand clicks" has long been associated with added burnout and is a factor in workforce shortages.

The link between digital maturity and workforce sustainability is the subject of future research by Snowdon, if she can get the data. 

"The evidence is profoundly limited," she said. 

Snowdon asked a friend who is a nurse how many menus she had to pull down on the information system to get what she wanted. The nurse told her she was thrilled when technology lowered the number of pull-down menus from 33 to 20, Snowdon said.

Stage 6 and 7 organizations are far more likely to retain nurses, she said, due to having up-to-date, interoperable, real-time data that's easily accessible.

WHY THIS MATTERS

HIMSS provides guidance worldwide for health systems to achieve digital maturity, which is associated with a digitally enabled work environment that has an automated flow of data across information systems.

The Electronic Medical Record Adoption Model (EMRAM), developed by HIMSS Analytics, has become a universally recognized maturation model of a hospital's electronic medical record (EMR) environment, according to the National Institutes of Health. 

HIMSS is the parent company of Healthcare Finance News, Healthcare IT News and Mobi Health News.

Snowdon said she set out to determine whether digital maturity makes a difference in patient care by using quality and safety measures done independently by Leapfrog, an organization not associated with HIMSS.

The results of her research, "Digital Maturity as a Predictor of Quality and Safety Outcomes in US Hospitals: Cross-Sectional Observational Study," has been published in professional journals, and most recently, on August 8, in the NIH National Library of Medicine.

"Digital maturing is not really about the EHR," Snowdon said. "It's about the EHR and the degree to which an organization has made that EHR integrate seamlessly with the other software systems."

This includes pharmacy systems to know the drugs patients are taking, labs, imaging and other information such as cardiac catheterizations. 

"They all have separate software that makes them work," she said. "Same as medical devices, it's another software system."

But systems must make use of the functionality of their EHRs to integrate these systems. 

"There's a ton of organizations that have never turned on functionality," she said.

Digital maturity is expensive and hard to implement, Snowdon said. 

But the research shows, "if you don't do it, you give kind of mediocre quality care."

THE LARGER TREND

Snowdon has also done a study on the link between EMRAM and patient experience, which has been published in the Journal of Patient Experience.

The research used data from patient surveys known as HCAHPS, the Hospital Consumer Assessment of Healthcare Providers and Systems. 

"Generally every health system in the world wants to know, are patients satisfied," Snowdon said. "Does digital maturity make it better or worse for patients?"

HCAHPS are a component of the Hospital Star Ratings released annually by the Centers for Medicare and Medicaid Services. Eleven HCAHPS star ratings appear on Care Compare, the public website consumers can use to choose a hospital.

The findings from HCAHPS made clear that patient experience survey results from EMRAM hospitals were off the charts, Snowdon said. Patients deemed communication with nurses and doctors better. This was the case no matter what kind of hospital it was, private or nonprofit, she said.

One difference involved communication on discharges and care transitions. The findings were better only for medium and larger EMRAM hospitals, she said. For smaller hospitals, it was not as significant.

Snowdon is also working on a health equity paper that has been submitted to the Journal of the American Medical Association for consideration. It is about whether digital maturity in hospitals is associated with equitable care in the United States.

Snowdon has found that patients with the highest social disparities, 54% or more, are likely going to an EMRAN zero hospital. The most complex patients are going to hospitals that are least able to coordinate care because their systems are not connected, she said.

The digital divide between marginalized patients looks at social disparities by zip code and compares hospitals with and without EMRAM status within those zip codes. Those achieving EMRAM status showed superior results in managing the most vulnerable patients, she said.
 

Email the writer: SMorse@himss.org