Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis

Beauvais, Bradley; Kruse, Clemens Scott; Fulton, Lawrence; Shanmugam, Ramalingam; Ramamonjiarivelo, Zo; Brooks, Matthew

BACKGROUND: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. OBJECTIVE: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. METHODS: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value–Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. RESULTS: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R(2)=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R(2)=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R(2)=24.3%; β=−.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R(2)=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R(2)=4.2%). CONCLUSIONS: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.