To Err on the Side of EHR? The Effect of Electronic Health Records on Quality of Care, Costs, and Nurse Staffing in California

Abstract

Spending more healthcare expenditures per capita than any other country, but still performing poorly across multiple health indicators, the U.S. healthcare system is plagued with inefficiencies, high costs, and inconsistent quality of care. Electronic Health Records (EHRs) are expected to improve quality of care and reduce costs by both experts and policymakers alike. In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act to promote the adoption and meaningful use of EHRs through incentive payments. A decade later, the effect of EHRs on quality of care, costs, and other outcomes remain uncertain. To extend the literature, I use the most recent EHR, patient, and hospital data to study the impact of EHRs and EHR advancement levels on length of stay, inpatient mortality, patient charges, and nurse staffing in California hospitals from 2008 to 2014. I find that EHRs alone do not significantly improve quality of care outcomes, reduce costs, or impact nurse staffing. However, when EHRs operate with key components to meet functional and technical criteria, more sophisticated EHRs reduce length of stay. I find that intermediate EHRs are comparatively advantageous at reducing patient length of stay and that more advanced EHRs are associated with increases in patient charges. As the U.S. healthcare industry continues to face challenges on the fronts of efficiency, quality of care, and costs, EHRs and other health technology have the potential to address those challenges. While this study does not find that EHRs alone significantly improve quality of care, reduce costs, or impact nurse staffing, it does find that when EHRs are implemented and used meaningfully, they have the potential to improve healthcare.