Digital and Paper-Based Hospital Workflows and 60-Day Mortality in Acute Leukemia: Retrospective Natural Experiment

Area of Science:

• Health Informatics
• Oncology
• Public Health

Background:

• Electronic medical record (EMR) systems are linked to improved clinical workflows and reduced documentation errors.
• Limited data exists on the impact of EMRs on time-sensitive leukemia care in Latin American public hospitals.

Purpose of the Study:

• To compare 60-day mortality and urgent supportive care processes between two Mexican public hospitals with different documentation systems: integrated EMR versus traditional physical records (TPR).
• To test the hypothesis that digital workflows facilitate more timely leukemia treatment.

Main Methods:

• A retrospective natural experiment involving 274 newly diagnosed acute leukemia patients (February 2023 - April 2025).
• Data abstracted from institutional records included clinical characteristics, treatment intensity, complications, antibiotic timing, and survival outcomes.
• Primary outcome: 60-day mortality. Secondary outcomes: time to first antibiotic dose for febrile neutropenia, treatment complications, and operational steps for urgent care.

Main Results:

• Integrated EMR hospital had significantly lower 60-day mortality (5.8%) compared to TPR hospital (35.9%; P<.001).
• Time to first antibiotic dose after febrile neutropenia recognition was shorter in the EMR hospital (54 min) vs. TPR hospital (P<.001).
• EMR hospital showed better 60-day outcomes despite higher-intensity regimens; hospital type remained independently associated with reduced mortality (OR 0.11; P<.001).

Conclusions:

• Hospitals using integrated EMRs demonstrated lower 60-day mortality and faster antibiotic administration for leukemia patients compared to those using TPR.
• Findings suggest digital workflows may enhance timely urgent supportive care.
• Results are hypothesis-generating and require cautious interpretation due to the retrospective, two-center design and potential for confounding.