The impact of electronic health record implementation and use on performance of the Surgical Care Improvement Project measures

Abstract

Objective: To examine the impact of electronic health record (EHR) deployment on Surgical Care Improvement Project (SCIP) measures in a tertiary-care teaching hospital.

Data sources: SCIP Core Measure dataset from the CMS Hospital Inpatient Quality Reporting Program (March 2010 to February 2012).

Study design: One-group pre- and post-EHR logistic regression and difference-in-differences analyses.

Principal findings: Statistically significant short-term declines in scores were observed for the composite, postoperative removal of urinary catheter and post-cardiac surgery glucose control measures. A statistically insignificant improvement in scores for these measures was noted 3 months after EHR deployment.

Conclusion: The transition to an EHR appears to be associated with a short-term decline in quality. Implementation strategies should be developed to preempt or minimize this initial decline.

Keywords: Quality of care/patient safety (measurement); observational data/quasi-experiments; surgery.

Figure 1

Time Trends for Composite,^α SCIP-Inf-4,^β SCIP-Inf-9,^γ and SCIP-Card-2^δ Measures x-axis: study duration; y-axis: raw percentage score. ^αReflective of performance on all the Surgical Care Improvement Project measures. ^βCardiac surgery patients with controlled 6 a.m. postoperative blood glucose. ^γUrinary catheter removed on postoperative day 1 or 2. ^λSurgery patients on beta-blocker therapy prior to arrival who received a beta-blocker during the perioperative period. p-value for Chi-square or Fisher's exact tests for the difference in the SCIP scores at Strong Memorial Hospital and Highland Hospital prior to EHR deployment on March 5, 2011.