Effects of hospital digitization on clinical outcomes and patient satisfaction: Nationwide multiple regression analysis across German hospitals (Preprint)

Abstract

The adoption of Health Information Technology (HIT) by healthcare providers is commonly believed to improve the quality of care. Policymakers follow this logic and deploy multi-billion dollar nationwide HIT adoption programs to fund hospital investments in digital technologies such as Electronic Health Records (EHR). Yet, scientific evidence for the beneficial effects of HIT on clinical outcomes and patient satisfaction on a national level remains incomplete and rarely accounts for the value of digitization from a hospital user perspective.

The aim of this study is to examine the relationship between digitization on clinical outcomes and patient experience among German hospitals. Hereby, the study goes beyond assessing the effects of mere HIT adoption and considers user-perceived HIT value, as well. Hence, it aims at differentiating between mere availability and user-perceived quality of HIT. Additionally, the impact of a variety of technologies beyond EHRs is examined.

Multiple linear regression models were estimated with emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. Adoption and user-perceived value of HIT represented key independent variables and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted observed/expected outcome ratios for stroke, heart attack, and hip replacement patients. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 sub-domains of HIT and EHRs was derived from the German 2020 Healthcare IT Report.

Statistic analysis was based on an overall sample of 383 German hospitals. Based on the analyzed data, no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction was found. However, a higher user-perceived value of installed tools did improve outcomes. Whereas emergency care outcomes especially benefitted from user-friendly overall digitization (beta -0.032, P .042) especially driven by user-friendliness of admission-HIT (beta -0.023, P .073), elective care outcomes did so via user-friendly EHR installations (beta -0.138, P .008). Similarly, user-friendly overall digitization had a moderate positive effect on patient satisfaction (beta -0.009, P .014).

Hospital digitization is not an end in itself. Policymakers and hospitals are well-advised to not only focus on the mere adoption of digital technologies but to continuously work towards digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that benefits of single technologies are not realized across all care domains.