110 Chapter 8 Subquestion 2. What is the association between this degree of maturity of EMR systems of hospitals and the quality of care? Comparison of HIMSS Analytics EMRAM data with Elsevier’s ‘The Best Hospitals’ data – main findings chapter 3. This part of the thesis correlates the measured maturity level of EMR systems with the quality and safety used to score Dutch hospitals as presented in Elsevier’s annual ‘The Best Hospitals’ publication. The scores of the Elsevier publication are based upon 542 of the 1516 indicators from the publicly available basic set and the safety set of the Health Care Inspectorate (IGJ) and the Dutch Health Care Transparency Program ‘Zichtbare Zorg’ (ZIZO) program (both sets survey year 2013). Almost all hospital-wide indicator sets are included in the selection and a large portion of indicators are for acute care. Only those indicators for acute care are included that are delivered by all hospitals like infectious diseases, cardiovascular diseases and the surgical process. The scoring of the Elsevier model is mainly based (87%) upon so called ‘structure’ indicators whereas ‘Outcome’ or ‘process’ indicators are generally considered as better indicators for quality of care. 7 There was no significant correlation between the EMRAM scores and the Elsevier performance indicators. The occurrence of adverse events as measured by NIVEL and the level of digitization in Dutch hospitals – main findings chapter 4. The next step in this thesis was to compare the adverse events and unplanned readmissions in hospitals as measured by the Netherlands Institute for Health Services Research (NIVEL). To keep track of changes in patient safety at a national level, three patient safety measurements with patient records from 2004, 2008 and 2011/2012 have been carried out by the Netherlands Institute for Health Services Research (NIVEL) in a sample of 20 hospitals, out of the total of 93 Dutch hospitals. The sample was stratified for university, tertiary teaching and general hospitals. These studies demonstrated significant overall improvement over the years and showed that differences in patient safety outcomes exist between hospitals. Since digital maturity may lead to better hospital performance and outcomes, hospitals may use it to improve the quality of care. The key assumption to be explored in this study is that when basic digital clinical functionalities are available in a hospital (EMRAM>=3), patients will have a more effective and safe hospitalization compared to hospitals with lesser EMR-maturity. From the 20 hospitals selected by NIVEL, 17 are also measured in the EMRAM study, leaving 17 hospitals for this part of the thesis.
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