Electronic Health Records in the Post-HITECH Era: Rethinking Vendor Performance and Certification
The federal electronic health record certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. Despite this, there is widespread acknowledgement that EHR systems vary significantly in their design and functionality. We performed a national study of hospitals to determine if there was an association between EHR vendor choice performance on select Stage 2 Meaningful Use criteria.
Our results show that a nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, between 7% and 34% depending on the criteria. There were significant associations between vendor choice and meaningful use performance, with Epic being associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed. However, the majority of variation is unexplained by observable hospital characteristics, including vendor.
Our results have important implications for both practitioners and policymakers. For practitioners, we find that choosing an EHR vendor is important if their organization is seeking high performance, but unobservable characteristics are perhaps even more important. Staff training, implementation, and continuous learning are some possible drivers of this unexplained variation. For policymakers, it is important to consider the goal of the EHR certification program going forward, and whether or not the purpose is to ensure simply baseline capability, or to relieve the burden of choice from providers.
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