Effect of electronic patient record use on mortality in End Stage Renal Disease, a model chronic disease: retrospective analysis of 9 years of prospectively collected data
Open accessAbstract
BACKGROUND: In chronic disease, health information technology promises but has yet to demonstrate improved outcomes and decreased costs. The main aim of the study was to determine the effects on mortality and cost of an electronic patient record used in daily patient care in a model chronic disease, End Stage Renal Disease, treated by chronic maintenance hemodialysis. Dialysis treatment is highly regulated, and near uniform in treatment modalities and drugs used. METHODS: The particular electronic patient record, patient-centered and extensively coded, was used first in patient care in 3 dialysis units in New York, NY in 1998, 1999, and 2000. All data were stored "live"; none were archived. By December 31, 2006, the patients had been treated by maintenance hemodialysis for a total of 3924 years. A retrospective analysis was made using query tools embedded in the software. The United States Renal Data System dialysis population served as controls. In all there were 1790 patients, with many underlying primary diseases and multiple comorbid conditions affecting many organ systems. Year by year mortality, hospital admissions, and staffing were analyzed, and the data were compared with national data compiled by the United States Renal Data System. RESULTS: Analyzed by calendar year after electronic patient record implementation, mortality decreased strikingly. In years 3-9 mortality was lower than in years 1-2 by 23%, 48%, and 34% in the 3 units, and was 37%, 37%, and 35% less than that reported by the United States Renal Data System. Clinical staffing was 25% fewer per 100 patients than the national average, thereby lowering costs. CONCLUSION: To our knowledge, this is the first demonstration that an electronic patient record, albeit of particular design, can have a favorable effect on outcomes and cost in chronic disease. That the population studied has many underlying diseases affecting all organ systems suggests that the electronic patient record design may enable application to many fields of medical practice.
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Existing literature on the benefits of electronic records is largely U.S. or primary care based and reports potential rather than actual benefits, with a large proportion of this evidence reporting the potential for electronic records to improve patient safety.
“Existing literature on the benefits of electronic records is largely U.S or primary care based [18–34] and reports ‘potential’ rather than actual benefits; with a large proportion of this evidence reporting the potential for electronic records to improve patient safety [19, 21, 23, 27–30].”
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- Authors
- Pollak, V. E., & Lorch, J. A.
- Affiliations
- The Rogosin Institute (US)
- Corresponding author
- Pollak, Victor E
- Venue
- BMC Medical Informatics and Decision Making
- Published
- 2007-11-28
- Volume
- 7
- Issue
- 1
- Pages
- 38-38
- ISSN
- 1472-6947 (ISSN-L)
- PMC
- PMC2238736
- OpenAlex
- W2146659596
- Cited by
- 40
- References
- 30
- Citations by year
- 2022: 1 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 1 · 2017: 4 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Cincinnati
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Keywords
- electronic health records, end-stage renal disease, maintenance hemodialysis, mortality, health information technology, chronic disease management, hospitalization, health care costs, United States Renal Data System
- MeSH terms
- Adult, Aged, Female, Forms and Records Control, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Medical Records, Problem-Oriented, Middle Aged, New York City, Prospective Studies, Software, Comorbidity, Medical Records Systems, Computerized, International Classification of Diseases
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