'Where to, Doc?' Electronic Health Record Systems and the Mobility of Chronic Care Patients

Electronic Health Record (EHR) systems enable the coordination of care across providers and locations by sharing information electronically. This is particularly important for patients with chronic conditions who require regular care from multiple specialists over a long period of time. EHR systems can allow patients with chronic conditions to coordinate their care from a network of ambulatory outpatient centers rather than a central inpatient location, and, as a result, patients can receive care at locations that are more convenient to them and offer better quality care. In this paper, we examine the adoption of EHR systems in inpatient and outpatient facilities, and its effects on mobility of patients with chronic conditions. The results showed multiple changes in the management of chronic care visits due to EHR systems. First, we found evidence that the adoption of EHR systems is associated with an increase in the number of ambulatory locations at which patients with chronic conditions receive their care. Second, these patients have a greater number of visits to those ambulatory centers. Third, patients interact with more healthcare providers at ambulatory centers, controlling for the increased number of visits. These effects on patient mobility are stronger in rural areas, and when the ambulatory centers are located close to inpatient centers. We also found that increased patient mobility is associated with lower healthcare costs. Finally, we discuss implications on patient mobility and the quality of care for patients with chronic conditions in ambulatory centers after the adoption of EHR systems.