Rationale: Computerized patient records and bar code medication systems are gaining favor in the health care industry. These systems are believed to reduce patient care errors and improve the work environment for medical professionals, although there is little objective research on the effects of these systems on patient care and staff morale. In the late 1990s, the Veterans Health Administration (VHA) implemented two major information systems to enhance record-keeping and quality of care. The Computerized Patient Record System (CPRS), phased in over the past decade, consists of a comprehensive electronic patient medical record, including outpatient and inpatient services. The Bar Code Medication Administration (BCMA) system, which was in all VA medical centers by 1999, created a computerized pharmacy ordering, distribution, and administration system for use in the inpatient setting. These two systems are among the largest investments in information technology in the hospital industry over the past decade, and the VA has been a leader in implementing information technology. Objectives: This paper examines the effects of CPRS and BCMA on adverse events experienced by patients. Methodology: Several VA data systems provide data about patient outcomes. Patient outcomes are measured using the AHRQ Patient Safety Indicators and Inpatient Quality Indicators. Other patient outcomes measures, such as those used by Needleman and Buerhaus, also are used. All VA facilities were surveyed to obtain exact implementation dates of modules of CPRS and BCMA. The effects of CPRS and BCMA on staffing and outcomes are identified by estimating multivariate regression equations with panel data from the late 1990s through early 2000s. For each equation, the dependent variable is the patient outcome of interest, with the explanatory variables including whether CPRS or BCMA was implemented, patient characteristics, facility characteristics, staff characteristics, and other factors. The models will account for the phase-in periods of CPRS and BCMA, to distinguish between short-term changes in patient safety and long-term changes. Results: This study is underway, with preliminary results expected by March, 2007. The survey of VA facilities found that there was significant variation in the implementation dates of CPRS and BCMA, which assures that there is enough variation in the data to complete our analyses. We have extracted the Patient Safety Indicators, and are conducting site visits to provide qualitative data and more guidance about factors to consider in the econometric modeling
