57 Patient safety outcomes and their association with the level of digitization in Dutch hospitals • In hospitals with more advanced EMR capabilities the expected number of patients with AEs is smaller; • In hospitals with more advanced EMR capabilities the expected number of patients with preventable AEs is smaller; • In hospitals with more advanced EMR capabilities the expected number of patients with AEs caused by medication is smaller; • In hospitals with more advanced EMR capabilities the expected number of readmissions is smaller. • In hospitals with more advanced EMR capabilities the expected average Lengths of Stay (LOS) is shorter. Given the nature of this retrospective database study, associations that are demonstrated are considered exploratory, and will need further confirmation in subsequent research. METHODS EMRAM The scoring process is done (2012-2014) by identifying the software used in the different functional areas of the hospital. At least 150 questions per hospital are included about demographics, software functionalities, processes, integration standards, usage in percentage by physician and nurses, depending on the available software in the hospital.7 The surveys are filled in by the author of this manuscript in presence of the hospital officials in charge (mainly ICT, pharmacist, medical specialist). As clinical EMR capabilities (nursing/clinical documentation, flow sheets and basic decision support etc.), are implemented from EMRAM stage 3 and higher and the number of hospitals per EMRAM score is small, it was decided to split the hospitals into two groups: the lower EMRAM group with EMRAM-scores 0 to 2 (EMRAM012) and the higher EMRAM group (EMRAMscores 3 to 6 - EMRAM3456), with more advanced clinical functionalities. Dutch Adverse Event Study The details of the design of the Dutch Adverse Event study has been published elsewhere.13 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 in the Netherlands in this study. As the EMRAM study took place in 2012-2014 only patients measured during the last study in 2011/2012 of this large retrospective patient record review study were used. A retrospective patient record review study was 4
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