48 Chapter 3 DISCUSSION The hypothesis of this study, that there is a positive association between advanced electronic medical record (EMR) capabilities and quality and safety of hospital care in The Netherlands was not supported at this point in time by the findings of this study. There are several reasons as to why these findings did not support the study hypothesis. For one, the models used to evaluate both the hospital’s EMR capabilities (the EMRAM model) and the quality and safety of hospital care in NL (the Elsevier model) may not be as sensitive as needed to capture the variances in performance outcomes. The EMRAM scoring approach for example, may over-inflate a hospital’s true EMR capabilities. While the EMRAM framework was designed to give guidance for the sequence of implementing EMR functionalities in hospitals by scoring hospitals on the “presence” of EMR tools, the “pervasiveness” of EMR tool use is not addressed until higher stages of the model. As such, hospitals could qualify as a stage 4 hospital if the required functionalities and facilities are implemented in only one patient care service area in the hospital even though other parts of the hospital reflect the capabilities of lower EMRAM stages. As such, it is possible that hospitals are not fully realizing the quality and safety benefits of their EMR because the tool’s use is not universally employed throughout the hospital, even though they are recognized as having fairly advanced EMR capabilities. Secondly the Elsevier model. The scoring of the Elsevier model is mainly based (87 %) upon so called ‘structure’ indicators. The ‘effective treatment’ indicator is based upon 62 (100 %) ‘structure’ indicators. ‘Outcome’ or ‘process’ indicators are generally considered as better indicators for quality of care.18 Transparency of hospitals is a big issue in the NL (as is abroad) because even if outcome indicators are measured, they are most of the time not available for publication. To illustrate the dispute in the Netherlands, the ministry of Health made 2015 the year of the transparency. However, it could be that not only methodological limitations in this paper explain the absence of a positive relation between digitalization and quality of care. Recent literature 19,20 has indicated and discussed comparable findings. In the study of Jarvis 16 of 2988 hospitals with EMRAM scores in the USA, 248 were classified as ‘advanced EMR use’ (EMRAM stage 6 or 7). The remaining hospitals were classified as ‘non-advanced EMR use’. Estimated clinical process of care and patient
RkJQdWJsaXNoZXIy MjY0ODMw