Association for Public Policy Analysis & Management

In this paper, we examine how hospital adoption of Electronic Medical Records (EMRs) impacts medical procedure choice. Despite hopes that EMRs will improve health outcomes and reduce costs by assisting providers in delivering more efficient medical care, little research with large-scale data has been conducted to understand how EMRs affect practitioners’ medical decision making. Our paper provides a unique contribution by tying the literature on the effects of EMR adoption to the literature on the utilization of expensive medical technology. In particular, we study the use of Cesarean section deliveries. C-sections are often considered an over-utilized procedure, as they have been increasingly performed on low acuity mothers in recent decades. We explore whether EMR adoption by hospitals assists providers in matching patients to the most appropriate procedure, given their medical condition. More appropriate patient-procedure matching could improve health outcomes and reduce treatment costs if it reduces the prevalence of C-sections among lower-acuity mothers.  We find that EMR adoption by hospitals does reduce C-section rates for some low-risk mothers; however, we find this effect occurs predominantly in hospitals that were already performing fewer C-sections. EMRs appear to help physicians and hospitals already working to curb C-section rates do so more effectively, but do not appear to change the behavior of already high-intensity providers.