Hospitals with better IT have fewer deaths, study shows

Computerworld - The level of technology deployed by hospitals to help doctors and nurses automate their work can mean the difference between life and death, according to a recently reported study. The study, involving more than 167,000 patients in 41 hospitals, also showed that better IT lowered costs.

According to an abstract of the study, published in the Jan. 26 issue of the Archives of Internal Medicine, "hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs." That's according to the study's author, Dr. Ruben Amarasingham, associate chief of medicine at Parkland Health & Hospital System and an assistant professor of medicine at the University of Texas Southwestern Medical Center. Both are located in Dallas.

Comparing in-patient death rates, medical complications, length-of-stay and costs, the study showed that hospitals with the greatest level of automation saved up to $1,729 per patient for procedures such as coronary artery bypass grafting.

The study was a collaborative effort by several universities, including Parkland Health & Hospital System and the University of Texas Southwestern Medical Center; and Johns Hopkins University's School of Medicine and Bloomberg School of Public Health. It measured the amount of medical care automation with a Clinical Information Technology Assessment Tool, a survey-based metric that assesses the automation and ease of use of a hospital's information system.

The study looked at four common medical conditions and how technology was used to automate the treatment process. Those conditions included heart attacks, congestive heart failure, coronary artery bypass grafting and pneumonia.

The survey tool measured automation in four areas that would normally be paper based: physician notes and patient records; lab test results; physician order entry; and decision support. The survey also asked doctors about how effective and easy the systems are to use.

The level of IT was rated on a 100-point scale, with zero being the lowest possible score.

A 10-point increase in the automation of medical notes and patient records was associated with a 15% decrease in deaths, the study showed. Hospitals with that level of technology had a 1.4% patient mortality rate compared with a 1.9% among hospitals with the lowest level of automation. "This would suggest that for every 1,000 patients, five [or] fewer patients die at hospitals with the highest notes and records scores," the study said.

The study collected information on 167,000 patients over the age of 50.

Better automated order-entry systems were associated with a 9% drop in the risk of a heart attack and a 55% decrease in the need for coronary artery bypass graft procedures.

And while automation in the computer systems designed to help doctors and nurses make medical decisions correlated with a decrease in complications of up to 16%, automating medical test results didn't seem to make much difference.

President Barack Obama has said that he hopes to spend up to $50 billion over the next five years to create a more automated national health care system. That system, once in place, would include the technologies included in the physician study.

Currently, between a quarter and a third of the nation's 5,000 hospitals use -- or are in the process of rolling out -- computerized order-entry and medical record systems, according to Dr. David Brailer, who served as President George W. Bush's health information czar from 2004 to 2006. Full electronic health record systems include patient care order-entry systems and networks to share patient data between hospitals, primary care physicians and insurance companies, and to fill pharmacy prescriptions.

Conducted between Dec. 1, 2005, and May 30, 2006, the study involved surveys sent to five randomly chosen physicians in 72 general acute-care hospitals located within 10 geographically dispersed metropolitan statistical areas in Texas, including Abilene, Austin, Dallas, El Paso, Houston, Laredo, Lubbock, McAllen, San Angelo and San Antonio. There were enough responses -- from five physicians or more -- from 41 of those 72 hospitals.

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