Electronic medical records and quality of care: exploration of the effects of EMR use on the quality of hospital care

Implementations of potentially transformative eHealth technologies are currently underway internationally, often with significant impact on national expenditure. Such large-scale efforts and expenditures have been justified on the grounds that picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerized provider (or physician) order entry systems (CPOE), and computerized decision support systems (CDSS) are supposed to help to address the problems of variable quality and safety in modern health care. However, the scientific basis of such claims, which are repeatedly made, remains to be firmly established. This paper has the objective to contribute to the scientific discourse on the relationship between the digitalization of hospital care and quality and safety of such care by exploring the experience in the Netherlands. The central question of this thesis is: What is the relation between the maturity of hospital EMR systems and the quality of care. The three sub-studies showed little or no association between maturity and quality of care. We found that implementing clinical documentation, especially nursing documentation, ‘Closed Loop Medication Administration’, and intelligent pathways including CDSS, present as a challenge. The interviewed medical specialists prefer digital over the old paper records. The fact that involved health professionals can access the patient data at any time they need it, is considered important. However, in practice, potential quality improvement lags behind as long as decision support cannot be applied by lack of a fully coded patient record. We believe that Dutch hospitals are only at the beginning of a digital transformation. Moreover, a number of preconditions must also be met, such as the active involvement of professionals and management. It is not just a technical transformation but mainly an organizational one.