In the past two decades, healthcare systems around the world have been on a transformative journey, marked by the increasing adoption of Electronic Medical Records (EMR) and Electronic Health Records (EHR). These technologies, once seen as futuristic tools, are now central to modern healthcare, offering new ways to improve patient outcomes and reduce administrative burdens.
But do they truly save lives? A recent systematic review and meta-analysis, the Effects of Electronic Records on Patient Mortality by JSI in the USAID-funded Digital Health Activity, found a very interesting result: mature digital health systems save lives – immature systems cost lives.
The Promise of Digital Records
EHR and EMR are designed to streamline healthcare delivery by digitizing patient data. These tools promise more informed decision-making, fewer medical errors, and more personalized care by offering real-time access to patient histories, prescriptions, lab results, and even diagnostic support.
- EMR contains medical information about a patient within one healthcare organization
- EHR provides a comprehensive view of a patient’s health across multiple providers, promoting better coordination of care.
However, despite the widespread enthusiasm for digital health technologies, questions about their actual impact on critical outcomes, like mortality, have remained. Do these systems lead to better health outcomes, or are they simply another masterclass in wasting resources we don’t have?
Modest Reductions in Mortality
The review, which analyzed data from 42 studies conducted between 1998 and 2022, provides some promising answers. The research showed that the implementation of EMR and EHR systems in hospitals, intensive care units, and primary healthcare settings is associated with a statistically significant reduction in patient mortality. Specifically, the pooled estimate from the meta-analysis revealed that these digital systems reduced mortality by about 3-7%.
While this may seem like a modest improvement, it’s important to recognize that even small percentage reductions in mortality can translate into thousands of lives saved globally. For instance, in a large hospital system that handles just one hundred thousand patients annually, a 5% reduction in mortality can represent 5,000 lives saved.
Mixed Results in Different Contexts
Despite the overall positive findings, the review noted that the effects of EMR and EHR systems on mortality were not universally consistent across all studies. Approximately one-third of the studies showed no significant effect on mortality, and two studies even reported an increase in mortality rates following the implementation of these systems.
Why the discrepancy? The review suggests several digital health factors that could influence the outcomes, including the maturity of the EHR system, the specific features implemented, and the duration of exposure to the technology.
For instance, hospitals that had more mature EHR systems with advanced functionalities—such as Clinical Decision Support (CDS) and Computerized Physician Order Entry (CPOE)—tended to report better outcomes. Conversely, facilities that were in the early stages of EHR implementation, where staff might still be adapting to the new systems, sometimes saw a negative or neutral impact on patient outcomes.
The Role of System Maturity
One of the most striking findings from the review was the importance of system maturity. EHR systems that had been in place for several years were associated with much stronger reductions in mortality. This suggests that as healthcare providers and administrators become more familiar with the systems, and as the systems themselves improve, the potential for better outcomes increases.
For instance, advanced features like CDS, which can alert healthcare providers to potential medication interactions or remind them of critical care protocols, can play a significant role in reducing errors and improving patient safety. The review found that hospitals with CDS integrated into their EHR systems were more likely to report reductions in mortality.
Similarly, CPOE systems, which allow healthcare providers to enter medical orders electronically, can reduce transcription errors and streamline workflows. The review cited studies showing that the use of CPOE in intensive care units led to significant reductions in medication errors and, consequently, patient mortality.
Challenges and Limitations
The review highlights the potential of EMR and EHR systems to improve patient outcomes and points to several challenges. The initial phase of implementation can be difficult, with some studies showing a short-term increase in mortality rates. This is likely due to the learning curve associated with adopting new technologies, as healthcare providers may take time to adjust to the new systems, leading to errors or delays in care.
Another challenge is the variability in system features across different healthcare settings. Not all EMR and EHR systems are created equal, and the specific functionalities available can vary widely. For example, an EHR system with robust interoperability features—which allows patient data to be shared seamlessly between different healthcare providers—can lead to better coordination of care and improved outcomes. In contrast, systems with limited interoperability may not have the same positive impact.
The Future of EHRs in Global Health
The overall findings of the review are encouraging. As EMR and EHR systems continue to evolve and become more widespread, their potential to save lives could grow even further. For low- and middle-income countries, where healthcare resources are often limited, the adoption of digital health technologies offers a unique opportunity to leapfrog traditional healthcare models and improve patient outcomes on a large scale.
Moreover, as global health systems grapple with the challenges of aging populations and rising chronic disease burdens, the role of digital health technologies will become increasingly important. EMR and EHR systems are not a panacea, their potential to improve patient outcomes, including reductions in mortality, is clear.
With continued investment in technology, training, and system integration, the future of digital health looks promising—potentially saving countless lives in the years to come.
A lightly edited synopsis of Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses by Tariku Nigatu Bogale, Lemma Derseh, Loko Abraham, Herman Willems, Jonathan Metzger, Biruhtesfa Abere, Mesfin Tilaye, Tewodros Hailegeberel and Tadesse Alemu Bekele
