Texas hospital study points to benefits of automation

Patients at Texas hospitals that have automated some of their health information systems appear to have fewer complications, lower death rates and reduced costs, according to a report in the Jan. 26 issue of Archives of Internal Medicine.

Many of the technologies addressed in the study, which was supported by a grant from the Commonwealth Fund, helped the hospitals reduce waste as well as improve quality and keep tabs on performance, the report concluded.

"In recent years, American healthcare has been criticized as fragmented, expensive, unsafe and unfair," the authors wrote. "Clinical or health information technologies, such as electronic medical records, computerized provider order entry systems and clinical decision support systems, have emerged as one antidote, promising reductions in waste, gains in communication, improvements in quality and new accountabilities through automated performance measurement."

However, David Bates, MD, of Brigham and Women's Hospital in Boston, says the data gathered for the study is circumstantial.

"At the end of the day, does this article mean that hospitals should now climb on the health information technology bandwagon?" he asked in an accompanying editorial. "The data are too circumstantial to answer this definitively, but they provide another extremely important set of results."

A hospital's clinical information system can be divided into four categories, the authors noted: medical notes and records, test results, order entry and decision support.

Ruben Amarasingham, MD, of Parkland Health & Hospital System and University of Texas Southwestern Medical Center in Dallas, and colleagues compared urban hospitals in Texas using a tool that measures physicians' interactions with the information system.

Physicians from 41 hospitals rated their facilities' automation in each of the four areas in surveys taken in 2005 and 2006. The researchers then examined rates of inpatient death, complications, costs and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same timeframe.

For all of the medical conditions studied, increased automation of notes and records was associated with a 15-percent decrease in the odds of in-hospital death.

At hospitals with higher order entry scores, those with heart attacks had 9 percent lower odds of death, and those undergoing coronary artery bypass graft had 55 percent lower odds of death.

Patients with all causes of hospitalization had 16 percent lower odds of developing complications at hospitals whose decision support systems were highly automated.

"Higher scores on test results, order entry and decision support were associated with lower costs for all hospital admissions ($110, $132 and $538 less, respectively)," the authors wrote.

"Prior reports have suggested that decision support helps healthcare providers manage large amounts of incoming data, provides context for decision-making in light of guidelines and may help physicians avoid 'sins of omission,' reputed by some authors to be the largest source of medical errors," they continued. "Knowledge aids provided in this fashion could reduce the risk of complications and possibly death, providing a theoretical basis for the association we observed."

The authors found that for certain conditions greater automation appeared to result in a reduction in deaths, complications and cost.