O3204: Association Between Electronic Health Record Implementations and Adverse Events in Pediatric Hospitals

Background: Electronic health records (EHR) systems are now nearly ubiquitous in health systems across the country with many institutions having recently undergone or planning to undergo transitions between EHR systems. Implementing an EHR system is one of the most complex and disruptive operational tasks a health system can experience. Though anecdotally there are single site reports of adverse events occurring around the time of EHR implementations, there is limited research into this phenomenon, particularly in pediatrics. We utilized data from Solutions for Patient Safety, a network of 145+ children’s hospitals that share data and protocols to reduce harm in pediatric healthcare delivery, to study the association between EHR implementations and patient harm from hospital-acquired conditions (HACs).

Methods: We conducted a survey of EHR vendors and IT leaders at pediatric institutions to identify EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the Solutions for Patient Safety database to create an anonymized dataset of monthly HAC rates in the 7 months preceding and succeeding the implementation. Analysis was done using dates relative to EHR go-live (months -7 to +7). Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events (ADE), surgical site infections (SSI), pressure injuries (PI), and falls. Only institutions with full data for at least one HAC were included. Monthly event rates were plotted against relative month and inspected visually. To determine if there was a statistically significant temporal association with EHR implementation, the observation period was divided into three eras: before (months -7 to -3), during (months -2 to +2), and after go-live (months +3 to +7). Average monthly HAC rates were calculated across eras. Paired t-tests were performed to compare HAC rates between the eras. The Bonferroni method was used to calculate p-value thresholds that would assure a 5% risk of Type I error (p = 0.0028).

Results: 43 EHR implementations at pediatric hospitals were identified, of which 27 were included for analysis. Average HAC rates by relative month to EHR go-live showed no increase around the time of go-live (Figure). There was no increase in average HAC rates in the months during go-live compared to the months preceding it (Table). After correcting for multiple hypothesis testing, there were no statistically significant observations.

Conclusion: This observational multi-site study discovered no meaningful increase in hospital-acquired condition rates around EHR implementations at pediatric institutions. This is consistent with a 2016 study by Barnett et al. of adult hospitals, which also found no association between adverse inpatient outcomes and EHR transitions. These findings extend the literature around EHR implementations in pediatrics, which primarily consists of conflicting anecdotal reports.