Meaningful Use of Electronic Health Record Systems and Process Quality of Care: Evidence from a Panel Data Analysis of U.S. Acute-Care Hospitals


Address correspondence to Ajit Appari, Ph.D., Center for Digital Strategies, Tuck School of Business, Dartmouth College, 100 Tuck Hall, Hanover, NH 03755; e-mail: Ajit.Appari@Dartmouth.Edu



To estimate the incremental effects of transitions in electronic health record (EHR) system capabilities on hospital process quality.

Data Source

Hospital Compare (process quality), Health Information and Management Systems Society Analytics (EHR use), and Inpatient Prospective Payment System (hospital characteristics) for 2006–2010.

Study Setting

Hospital EHR systems were categorized into five levels (Level_0 to Level_4) based on use of eight clinical applications. Level_3 systems can meet 2011 EHR “meaningful use” objectives. Process quality was measured as composite scores on a 100-point scale for heart attack, heart failure, pneumonia, and surgical care infection prevention. Statistical analyses were conducted using fixed effects linear panel regression model for all hospitals, hospitals stratified on condition-specific baseline quality, and for large hospitals.

Principal Findings

Among all hospitals, implementing Level_3 systems yielded an incremental 0.35–0.49 percentage point increase in quality (over Level_2) across three conditions. Hospitals in bottom quartile of baseline quality increased 1.16–1.61 percentage points across three conditions for reaching Level_3. However, transitioning to Level_4 yielded an incremental decrease of 0.90–1.0 points for three conditions among all hospitals and 0.65–1.78 for bottom quartile hospitals.


Hospitals transitioning to EHR systems capable of meeting 2011 meaningful use objectives improved process quality, and lower quality hospitals experienced even higher gains. However, hospitals that transitioned to more advanced systems saw quality declines.