Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3068 — The Effect of the Computerized Patient Record System and the Bar Coding Medication Administration System on VA Patient Outcomes

Phibbs CS (Health Economics Resource Center) , Spetz J (University of California, San Francisco)

Computerized patient records and bar code medication systems are believed to reduce patient care errors and improve the work environment for medical professionals, although there is little objective research on the effects of these systems on patient care. In the late 1990s, VA implemented two major information systems to enhance record-keeping and quality of care. The Computerized Patient Record System (CPRS) consists of a comprehensive electronic patient medical record. The Bar Code Medication Administration (BCMA) system created a computerized pharmacy ordering, distribution, and administration system for inpatient care. These systems are among the largest investments in information technology in the hospital industry over the past decade, and the VA has been a leader in implementing information technology. This study examined the effects of CPRS and BCMA on adverse events experienced by inpatients. The project will also eventually examine the effects of CPRS and BCMA on nurse staffing.

Patient outcomes were measured using the AHRQ Patient Safety Indicators (PSI) and Inpatient Quality Indicators (IQI). All VA facilities were surveyed to obtain exact implementation dates for partial and complete implementation of modules of CPRS and BCMA. The variation in implementation dates was used as a natural experiment. The effects of CPRS and BCMA on outcomes were identified by estimating multivariate regression equations with panel data from the late 1990s through early 2000s. For each equation, the dependent variable was the outcome of interest, with the explanatory variables including whether CPRS or BCMA was implemented, patient characteristics, facility characteristics, and other factors.

Data about implementation dates of modules of CPRS and BCMA were obtained for 115 VA facilities. Initial analysis for a subset of the PSIs found mostly negative associations between CPRS or BCMA and PSIs, but most were not statistically significant.

Our initial analyses have found only a limited effect of CPRS and BCMA on serious adverse patient outcomes for inpatient care. Additional analyses are underway with other outcome measures which may be more sensitive.

While still beneficial, the effects of CPRS and BCMA may not be as large as some advocates claim.