Graduation Date

Fall 12-16-2016

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Li-Wu Chen, Ph.D.


The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is the goal of the program. The objective of this dissertation is to study the impact of EHRs on healthcare service delivery outcomes related to e-health services and productivity. Furthermore, the objectives are to study the impact of EHRs and Meaningful Use attestation on patient safety and inpatient quality of care.

The results demonstrate gains in efficiency may be achieved during patient-physician interaction time with the use of fully EHRs, where physicians saved 1.53 minutes per visit in time spent with the patient, or a 6.1% gain in efficiency. EHR use significantly improved the odds of providing e-billing, e-consults, and e-prescribing. We found that fully-implemented EHRs that did not attest to Meaningful Use had a significant positive impact on 3 patient safety outcomes, and hospitals that attested to Meaningful Use had a significant positive impact on 2 patient safety outcomes. However, there were no significant differences in patient safety composite scores. Last, there were significant differences in inpatient quality composite scores. Hospitals attesting to Meaningful Use had 18% improvements in mortality for selected conditions, and 8% improvements in mortality for selected procedures.

In conclusion, EHRs and the Meaningful Use program have had positive impacts on healthcare service delivery and inpatient quality of care. More efforts may be needed to improve patient safety with the use of EHRs, which may need to focus on EHR certification or Meaningful Use objectives. Future studies should determine specific EHR functionalities and Meaningful Use objectives that are associated with positive outcomes to further direct policy development.