Despite substantial national investment in electronic health records (EHRs) under the HITECH Act, studies linking EHR adoption to healthcare quality have yielded mixed results. Most prior studies measure hospital EHR adoption as a binary measure (eg, does a hospital have an EHR in a given year or not?). However, in hospital settings, it is more typical for adoption to occur incrementally over time.

For a study published in Health Affairs, we used Medicare claims data from 2008-2013 and data from the American Hospital Association’s Annual Survey to examine how risk-adjusted mortality rates varied with three measures of EHR adoption. Specifically, we measured (1) baseline level of EHR functionality (or the number of basic EHR functions a hospital had in 2008), (2) the maturation of those functions over time, and (3) the addition of new functions over time.

We found that greater adoption of EHR functions was associated with higher mortality rates in 2008; however, maturation of these EHR functions and the adoption of new functions was associated with decreases in mortality rates each year. Each function present in 2008 was associated with a 0.11 percentage point higher mortality rate in 2008. However, each function present in 2008 was associated with a 0.09 percentage point decrease in mortality rate with each passing year, and each newly adopted function was associated with a 0.21 percentage point decrease in mortality rate each year. This effect was primarily driven by small (<399 beds) hospitals and non-teaching hospitals.

Our results suggest that the national investment in EHRs is yielding improvements in hospital quality, but the challenges and difficulties are worth it—EHRs do contribute to better hospital quality, but it takes patience, time, and effort to get there.