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Electronic Health Record Adoption and Rates of In-hospital Adverse Events

Furukawa, Michael F. PhD; Eldridge, Noel MS; Wang, Yun PhD; Metersky, Mark MD
doi: 10.1097/PTS.0000000000000257
Original Article: PDF Only


Nationwide initiatives have focused on improving patient safety through greater use of health information technology. We examined the association of hospitals’ electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients.


We conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System. The sample included patients age 18 and older that were hospitalized for one of 3 conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and postprocedural events. Adverse event rates and patient exposure to a fully electronic EHR were determined through chart abstraction.


Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13.0% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, patient exposure to a fully electronic EHR was associated with 17% to 30% lower odds of any adverse event for cardiovascular (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.72–0.90), pneumonia (OR, 0.70; CI, 0.62–0.80), and surgery (OR, 0.83; CI, 0.72–0.96) patients. The associations of EHR adoption and adverse events varied by event type and by medical condition.


Cardiovascular, pneumonia, and surgery patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.

Correspondence: Noel Eldridge, MS, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857 (e-mail:

Funding Statement: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing Interests Statement: The authors have no competing interests to declare.

Contributorship Statement: MF and NE developed the initial idea. MF, NE, YW, and MM collaborated on study conceptualization and design. YW analyzed the data. MF, NE, YW, and MM interpreted results and wrote the manuscript.

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