Abstract：
BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected.
OBJECTIVE: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model.
METHODS: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios.
RESULTS: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties.
CONCLUSIONS: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.
OBJECTIVE: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model.
METHODS: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios.
RESULTS: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties.
CONCLUSIONS: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.
摘要：
背景：2009年《健康信息技术促进经济和临床健康法》旨在降低医疗保健成本，提高质量,增加患者安全。为了实现这一目标，鼓励提供商和组织展示有意义地使用经认证的电子健康记录（EHR）系统。采用EHR是一项昂贵的投资，考虑到所投资的资源和资本。由于投资成本，EHR采用投资的回报是预期的。
目的：本研究对EHR进行了价值分析。这项研究的目的是通过将财务和临床结果结合到一个概念模型中来调查EHR采用水平与财务和临床结果之间的关系。
方法：我们检查了不同水平的EHR采用与财务和临床结果之间的多变量关系，以及时变控制变量，使用纵向固定效应模型的适度分析。由于尚不清楚医院何时开始改善财务结果，额外的分析是使用1年或2年的利润率滞后进行的。
结果：在4年的过程中，共分析了5768个医院年的观察结果。根据适度分析的结果，随着再入院率增加1个单位，EHR采用水平增加1个单位对营业利润率的影响减少了5.38%。再入院支付调整因素较高的医院处罚较低。
结论：本研究通过评估EHR采用水平与财务和临床结果之间的个体关系，填补了文献中的空白。除了评估EHR采用水平与财务结果之间的关系外，以临床结果为调节因子。这项研究提供了具有统计学意义的证据(P<0.05)，表明当EHR采用水平和营业利润率之间存在关系时，这种关系由再入院率调节，这意味着采用EHR的医院可以看到其再入院率的降低和营业利润率的增加。这一发现可以通过评估更多最近的数据来进一步支持，以分析医院是否增加其EHR采用水平会降低再入院率。导致营业利润率增加。由于再入院率的提高，医院将受到较低的处罚，这将有助于提高营业利润率。
目的：本研究对EHR进行了价值分析。这项研究的目的是通过将财务和临床结果结合到一个概念模型中来调查EHR采用水平与财务和临床结果之间的关系。
方法：我们检查了不同水平的EHR采用与财务和临床结果之间的多变量关系，以及时变控制变量，使用纵向固定效应模型的适度分析。由于尚不清楚医院何时开始改善财务结果，额外的分析是使用1年或2年的利润率滞后进行的。
结果：在4年的过程中，共分析了5768个医院年的观察结果。根据适度分析的结果，随着再入院率增加1个单位，EHR采用水平增加1个单位对营业利润率的影响减少了5.38%。再入院支付调整因素较高的医院处罚较低。
结论：本研究通过评估EHR采用水平与财务和临床结果之间的个体关系，填补了文献中的空白。除了评估EHR采用水平与财务结果之间的关系外，以临床结果为调节因子。这项研究提供了具有统计学意义的证据(P<0.05)，表明当EHR采用水平和营业利润率之间存在关系时，这种关系由再入院率调节，这意味着采用EHR的医院可以看到其再入院率的降低和营业利润率的增加。这一发现可以通过评估更多最近的数据来进一步支持，以分析医院是否增加其EHR采用水平会降低再入院率。导致营业利润率增加。由于再入院率的提高，医院将受到较低的处罚，这将有助于提高营业利润率。
