J Am Med Inform Assoc 19:360-367 doi:10.1136/amiajnl-2011-000289
  • Research and applications
  • Focus on health information technology, electronic health records and their financial impact

Medication administration quality and health information technology: a national study of US hospitals

Editor's Choice
  1. Denise L Anthony3
  1. 1Tuck School of Business, Dartmouth College, Hanover, New Hampshire, USA
  2. 2Dartmouth College, Hanover, New Hampshire, USA
  3. 3Department of Sociology, Dartmouth College, Hanover, New Hampshire, USA
  1. Correspondence to Dr Ajit Appari, Tuck School of Business, Dartmouth College, 100 Tuck Hall, Hanover, NH 03755, USA; ajit.appari{at}
  • Received 29 March 2011
  • Accepted 26 September 2011
  • Published Online First 28 October 2011


Objective To determine whether the use of computerized physician order entry (CPOE) and electronic medication administration records (eMAR) is associated with better quality of medication administration at medium-to-large acute-care hospitals.

Data/study setting A retrospective cross-sectional analysis of data from three sources: CPOE/eMAR usage from HIMSS Analytics (2010), medication quality scores from CMS Hospital Compare (2010), and hospital characteristics from CMS Acute Inpatient Prospective Payment System (2009). The analysis focused on 11 quality indicators (January–December 2009) at 2603 medium-to-large (≥100 beds), non-federal acute-care hospitals measuring proportion of eligible patients given (or prescribed) recommended medications for conditions, including acute myocardial infarction, heart failure, and pneumonia, and surgical care improvement. Using technology adoption by 2008 as reference, hospitals were coded: (1) eMAR-only adopters (n=986); (2) CPOE-only adopters (n=115); and (3) adopters of both technologies (n=804); with non-adopters of both technologies as reference group (n=698). Hospitals were also coded for duration of use in 2-year increments since technology adoption. Hospital characteristics, historical measure-specific patient volume, and propensity scores for technology adoption were used to control for confounding factors. The analysis was performed using a generalized linear model (logit link and binomial family).

Principal findings Relative to non-adopters of both eMAR and CPOE, the odds of adherence to all measures (except one) were higher by 14–29% for eMAR-only hospitals and by 13–38% for hospitals with both technologies, translating to a marginal increase of 0.4–2.0 percentage points. Further, each additional 2 years of technology use was associated with 6–15% higher odds of compliance on all medication measures for eMAR-only hospitals and users of both technologies.

Conclusions Implementation and duration of use of health information technologies are associated with improved adherence to medication guidelines at US hospitals. The benefits are evident for adoption of eMAR systems alone and in combination with CPOE.


  • Funding National Science Foundation (NSF), Grant Number NSF-CNS-0910842; Rockefeller Center for Public Policy at Dartmouth College. Neither National Science Foundation nor Rockefeller Center for Public Policy at Dartmouth College had any role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, or the approval of manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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