Do Electronic Health Records Affect Quality of Care? Evidence from the HITECH Act

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act is landmark legislation that places electronic health record (EHR) technologies at the center of health system reform in the United States. However, despite their promises, studies in the EHR evaluation literature have found mixed evidence of EHRs' quality benefits. In contrast to existing research that has focused on EHR investments or adoption, we propose that its actual use should be the focus in evaluating the advantages of EHRs. We leveraged the meaningful use (MU) provisions of the HITECH Act to quantify different degrees of EHR use in a large and heterogeneous set of hospitals. The results provided evidence of EHRs' positive effects on quality of care and reconciled earlier mixed findings by showing that their benefits vary according to different levels of use and hospital characteristics. Specifically, we found that, although adopting EHRs had no significant quality impact, attaining MU of EHRs yielded a significant 0.19-0.43 percentage point increase in process quality of care, which further translates into significant societal benefits. The effect sizeswere larger in disadvantaged (i.e., small and rural) hospitals, suggesting the potential of EHRs in mitigating the disparities in the quality of healthcare. This study contributes to this ongoing discussion and the literature on EHR evaluations and use of information systems. Implications for research, policy, and practice are discussed.