Results from a large-scale Johns Hopkins study of more
than 40 hospitals and 160,000 patients
show that when health information technologies replace
paper forms and handwritten notes, both
hospitals and patients benefit strongly.
"Patients appear safer and hospital bottom lines may
improve when health care information is
gathered and stored on computers rather than on paper,"
said senior author Neil R. Powe, the James
F. Fries Professor of Medicine in the School of Medicine
and director of the
Welch Center for Prevention, Epidemiology and Clinical
Research.
In the study, published Jan. 26 in the Archives of
Internal Medicine, Powe, lead author Ruben
Amarasingham and colleagues rated clinical information
technologies at 41 hospitals in Texas and
compared those results with discharge information for
167,233 patients. Amarasingham was a Robert
Wood Johnson Clinical Scholar in the Johns Hopkins
Department of Medicine at the time the study
began.
"Previous studies only told us how well one particular
electronic system used by one particular
hospital worked," Amarasingham said. "This study gives us a
better sense about the general success of
paperless systems in a diverse set of community, academic
and safety-net hospitals. We were also able
to examine the many components contained in a hospital
information system."
Results showed that with computerized automation of
notes and records, hospitals whose
technologies ranked in the top third were associated with a
15 percent decrease in the odds that a
patient would die while hospitalized.
"If these results were to hold for all hospitals in
the United States, computerizing notes and
records might have the potential to save 100,000 lives
annually," Powe said.
Similarly, the highest scores for electronic "order
entry" systems were linked to a 9 percent
and 55 percent decrease in the odds of death from heart
attacks and coronary artery bypass
procedures, respectively.
The highest scores in computerized clinical
information that guides a physician's treatment
choices — so-called decision-support systems —
were associated with a 21 percent decrease in the odds
that a patient would develop complications.
The researchers also found that hospitals with the
highest technology scores in the rating
system showed significantly lower patient costs.
The paperless systems ranked by the Johns Hopkins team
included electronic notes; previous
treatment records; test results; orders for drugs,
procedures and blood tests; and decision-support
systems that offer up-to-date information on treatment
options and drug interactions.
To rate the effectiveness of the clinical information
technologies, the researchers developed a
questionnaire for physicians that asked whether an
electronic system was in place in their hospitals,
whether they knew how to use it and whether they used it
consistently. The questionnaire produced
numbered scores that allowed the researchers to place
hospitals in three groups, highest to lowest.
"Most prior studies did not focus on the success of
the interface between technology and
health care professionals," Powe said. "Our assessment tool
examines that important interface." Prior
to its use in Texas, the tool was successfully tested in
several pilot studies in hospitals around the
country.
Powe said he hopes that the results will not only
encourage more hospitals to go paperless but
also encourage broad use of this assessment tool to guide
hospitals in building better information
systems that improve health outcomes.
Amarasingham is an associate chief of medicine at
Parkland Health and Hospital System and
assistant professor of medicine at University of Texas
Southwestern Medical Center in Dallas. Other
researchers who contributed to this study are Marie
Diener-West, Darrell Gaskin and Laura Plantinga,
all of the Johns Hopkins Bloomberg School of Public
Health.