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How Health IT Adoption Affects Patient Satisfaction, HCAHPS

Health IT alone had little effect on two hospitals' HCAHPS and patient satisfaction scores.

By Sara Heath

As federal incentive programs such as meaningful use spark widespread EHR and health IT adoption, some healthcare professionals have questioned technology’s effects on patient satisfaction. According to researchers from a Delaware health system, health IT has very little effect on patient satisfaction measures such as HCAHPS scores.

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In a study published in the American Journal of Managed Care, researchers from Christiana Care Health System tested how computerized physician order entry (CPOE), electronic medication administration records (eMARs), and electronic progress notes (PN) affect the health system’s HCAHPS scores.

The team conducted a retrospective analysis comparing HCAHPS scores in 31 inpatient units before and after health IT implementation at two of the system’s facilities, Christiana Hospital and Wilmington Hospital.

Specifically, the research team looked at “top box” HCAHPS scores, which represent the highest possible category patients may select for a given survey question. For example, a top box score for nurse communication means that nurses always or usually communicate well with patients.

The team also looked at HCAHPS scores from “control periods” during which the hospital had not recently implemented any new health technologies. The researchers used control periods to understand how patients responded to health IT that staff had seamlessly integrated into workflow.

Analysis of the health system’s raw HCAHPS scores showed a modest increase in patient satisfaction during the test period of 2008-2015. When controlling for age, sex, race, and overall self-reported health, satisfaction score increases were negligible.

According to the researchers, these findings are contrary to some industry opinions that state improved physician workflow can help drive patient satisfaction scores.

“There has been speculation that health IT implementation contributing to patient satisfaction is related to streamlined clinician workflow allowing extra time for interactions with patients,” the researchers explained. “However, our study’s evaluation of tools that have been demonstrated to improve process efficiencies provides no evidence to support this relationship.”

Instead, the researchers suggested that health IT must be accompanied by other patient-centered strategies to improve patient satisfaction scores. However, it should be noted that the researchers did not disclose any non-health IT protocol implemented during any phase of the study.

For example, the researchers noted that the only time periods during which all satisfaction measures and top box scores increased were control periods. Patient satisfaction with the discharge process is one such area where the researchers saw this improvement.

“Our study similarly found statistically significant improvement in Discharge Information, but our methods linked the positive changes to control periods,” the researchers stated.

“Utilizing health IT for more efficient workflow—particularly for nurses who are consistently identified as primary drivers of patient satisfaction—may be a synergistic opportunity to optimize costs, quality, and patient experience, but the relationship requires further exploration.”

Ultimately, these findings suggest that providers assess different approaches they can take to integrate health IT into patient-centered care. While the results did not indicate that health IT detracts from patient satisfaction, providers will need to consider additional strategies to leverage technology for positive patient care.

“By determining how health IT utilization influences patient perceptions of their care, we aimed to inform stakeholders about opportunities to capitalize on existing synergistic effects to provide high-quality care while maximizing value-based reimbursements,” the researchers said.

For example, clinicians can enhance patient portal use by explaining to patients how to use the tool and the specific benefits it may have on their health.

Providers who are integrating an EHR into their workflows can improve patient satisfaction by leveraging interpersonal communication strategies instead of simply relying on the technology to improve efficiency.

Compound strategies – both health IT adoption and patient-centered care techniques – will be integral in ensuring patients are satisfied with the new technologies, the research team concluded.

“Our results suggest that investment in health IT appears to have no impact on patient satisfaction, as measured by HCAHPS scores,” they said. “Stakeholders should explore further opportunities for synergy as resources continue to be directed toward these 2 expensive and important initiatives.”

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