Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: Evidence from California Hospitals, 1998-2007

Michael F. Furukawa, Raghu Santanam, Benjamin Shao

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective. To estimate the effects of electronic medical records (EMR) implementation on medical-surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse-sensitive patient outcomes. Data Sources. Data on EMR implementation came from the 1998-2007 HIMSS Analytics Databases. Data on nurse staffing and patient outcomes came from the 1998-2007 Annual Financial Disclosure Reports and Patient Discharge Databases of the California Office of Statewide Health Planning and Development (OSHPD). Methods. Longitudinal analysis of an unbalanced panel of 326 short-term, general acute care hospitals in California. Marginal effects estimated using fixed effects (within-hospital) OLS regression. Principal Findings. EMR implementation was associated with 6-10 percent higher cost per discharge in medical-surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15-26 percent and reduced licensed vocational nurse cost per hour by 2-4 percent. EMR stage 3 was associated with 3-4 percent lower rates of in-hospital mortality for conditions. Conclusions. Our results suggest that advanced EMR applications may increase hospital costs and nurse staffing levels, as well as increase complications and decrease mortality for some conditions. Contrary to expectation, we found no support for the proposition that EMR reduced length of stay or decreased the demand for nurses.

Original languageEnglish (US)
Pages (from-to)941-962
Number of pages22
JournalHealth Services Research
Volume45
Issue number4
DOIs
StatePublished - Aug 2010

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Electronic Health Records
Nurses
Costs and Cost Analysis
Length of Stay
Databases
Health Planning
Patient Discharge
Hospital Costs
Information Storage and Retrieval
Disclosure
Hospital Mortality
Nursing
Mortality

Keywords

  • hospitals
  • Information technology in health
  • nursing

ASJC Scopus subject areas

  • Health Policy

Cite this

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