Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis

Abstract

Background: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear.

Objective: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance.

Methods: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value-Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure.

Results: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R²=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R²=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R²=24.3%; β=-.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R²=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R²=4.2%).

Conclusions: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.

Keywords: delivery of health care; electronic health records; financial management; hospitals; medical informatics; quality of health care; treatment outcome.