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Mavragani A, Chen Y, Yang H, Tao R, Chen X, Yu J. Investigation and Countermeasures Research of Hospital Information Construction of Tertiary Class-A Public Hospitals in China: Questionnaire Study. JMIR Form Res 2023; 7:e41820. [PMID: 36662565 PMCID: PMC9898827 DOI: 10.2196/41820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Medical informatization has initially demonstrated its advantages in improving the medical service industry. Over the past decade, the Chinese government have made a lot of effort to complete infrastructural information construction in the medical and health domain, and smart hospitals will be the next priority according to policies released by Chinese government in recent years. OBJECTIVE To provide strategic support for further development of medical information construction in China, this study aimed to investigate the current situation of medical information construction in tertiary class-A public hospitals and analyze the existing problems and countermeasures. METHODS This study surveyed 23 tertiary class-A public hospitals in China who voluntarily responded to a self-designed questionnaire distributed in April 2020 to investigate the current medical information construction status. Descriptive statistics were used to summarize the current configurations of hospital information department, hospital information systems, hospital internet service and its application, and the satisfaction of hospital information construction. Interviews were also conducted with the respondents in this study for requirement analysis. RESULTS The results show that hospital information construction has become one of the priorities of the hospitals' daily work, and the medical information infrastructural construction and internet service application of the hospitals are good; however, a remarkable gap among the different level of hospitals can be observed. Although most hospitals had built their own IT team to undertake information construction work, the actual utilization rate of big data collected and stored in the hospital information system was not satisfactory. CONCLUSIONS Support for the construction of information technology in primary care institutions should be increased to balance the level of development of medical informatization in medical institutions at all levels. The training of complex talents with both IT and medical backgrounds should be emphasized, and specialized disease information standards should be developed to lay a solid data foundation for data utilization and improve the utilization of medical big data.
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Affiliation(s)
| | - Yueyue Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiyuan Yang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Tao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Chen
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Yu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Likka MH, Kurihara Y. Analysis of the Effects of Electronic Medical Records and a Payment Scheme on the Length of Hospital Stay. Healthc Inform Res 2022; 28:35-45. [PMID: 35172089 PMCID: PMC8850176 DOI: 10.4258/hir.2022.28.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: This study analyzed the effects of computerization of medical information systems and a hospital payment scheme on medical care outcomes. Specifically, we examined the effects of Electronic Medical Records (EMRs) and a diagnosis procedure combination/per-diem payment scheme (DPC/PDPS) on the average length of hospital stay (ALOS).Methods: Post-intervention changes in the monthly ALOS were measured using an interrupted time-series analysis.Results: The level changes observed in the monthly ALOS immediately post-DPC/PDPS were –1.942 (95% confidence interval [CI], –2.856 to –1.028), –1.885 (95% CI, –3.176 to –0.593), –1.581 (95% CI, –3.081 to –0.082) and –2.461 (95% CI, –3.817 to 1.105) days in all ages, <50, 50–64, and ≥65 years, respectively. During the post-DPC/PDPS period, trends of 0.107 (95% CI, 0.069 to 0.144), 0.048 (95% CI, –0.006 to 0.101), 0.183 (95% CI, 0.122 to 0.245) and 0.110 (95% CI, 0.054 to 0.167) days/month, respectively, were observed. During the post-EMR period, trends of –0.053 (95% CI, –0.080 to –0.027), –0.093 (95% CI, –0.135 to –0.052), and –0.049 (95% CI, –0.087 to –0.012) days/month were seen for all ages, 50–64 and ≥65 years, respectively.Conclusions: The increasing post-DPC/PDPS trends offset the decline in ALOS observed immediately post-DPC/PDPS, and the observed ALOS was longer than the counterfactual at the end of the DPC/PDPS study periods. Conversely, due to the downward trend seen after EMR introduction, the actual ALOS at the end of the EMR study period was shorter than the counterfactual, suggesting that EMRs might be more effective than the DPC/PDPS in sustainably reducing the LOS.
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Affiliation(s)
- Melaku Haile Likka
- Information Healthcare Science Course, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi,
Japan
| | - Yukio Kurihara
- Healthcare Informatics Division, Basic Nursing Department, Medical School, Kochi University, Kochi,
Japan
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Sly B, Russell AW, Sullivan C. Digital interventions to improve safety and quality of inpatient diabetes management: A systematic review. Int J Med Inform 2021; 157:104596. [PMID: 34785487 DOI: 10.1016/j.ijmedinf.2021.104596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 09/01/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Diabetes is common amongst hospitalised patients and contributes to increased length of stay and poorer outcomes. Digital transformation, particularly the implementation of electronic medical records (EMRs), is rapidly occurring across the healthcare sector and provides an opportunity to improve the safety and quality of inpatient diabetes care. Alongside this revolution has been a considerable and ongoing evolution of digital interventions to optimise care of inpatients with diabetes including optimisation of EMRs, digital clinical decision support systems (CDSS) and solutions utilising data visibility to allow targeted patient review. OBJECTIVE To systematically appraise the recent literature to determine which digitally-enabled interventions including EMR, CDSS and data visibility solutions improve the safety and quality of non-critical care inpatient diabetes management. METHODS Pubmed, Embase and Cochrane databases were searched for suitable articles. Selected articles underwent quality assessment and analysis with results grouped by intervention type. RESULTS 1202 articles were identified with 42 meeting inclusion criteria. Four key interventions were identified; computerised physician order entry (n = 4), clinician decision support systems (n = 21), EMR driven active case finding (data visibility solutions) and targeted patient review (n = 10) and multicomponent system interventions (n = 7). Studies reported on glucometric outcomes, evidence-based medication ordering including medication errors, and patient and user outcomes. An improvement in glucometric measures particularly mean blood glucose and proportion of target range blood glucose levels and rates of evidence-based insulin prescribing were consistently demonstrated. CONCLUSION Digitally-enabled interventions utilised to improve quality and safety of inpatient diabetes care were heterogenous in design. The majority of studies across all intervention types reported positive effects for evidence-based prescribing and glucometric outcomes. There was less evidence for digital interventions reducing diabetes medication administration errors or impacting patient outcomes (length of stay).
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Affiliation(s)
- Benjamin Sly
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, 20 Weightman St, Herston, 4006 Brisbane, Australia; Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102 Brisbane, Australia.
| | - Anthony W Russell
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, 20 Weightman St, Herston, 4006 Brisbane, Australia; Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102 Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, 20 Weightman St, Herston, 4006 Brisbane, Australia; Metro North Hospital and Health Service, Butterfield St, Herston, 4029 Brisbane, Australia
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Developing and Sustaining an Open Source Electronic Health Record: Evidence from a Field Study in Japan. J Med Syst 2020; 44:159. [PMID: 32743682 DOI: 10.1007/s10916-020-01625-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Electronic Health Records (EHRs) are at the heart of reforms aimed at improving the efficiency and quality of healthcare services provided to citizens. Although there is still some skepticism, open source (OS) EHR is a growing phenomenon in health informatics. Given the widespread adoption of OS software (OSS) in several domains, including operating systems, and enterprise systems, the repeated shortfalls faced by healthcare organizations with dominant proprietary EHRs create an opportunity for other alternatives, such as OSS to demonstrate their abilities in addressing these well-documented problems, including inflexibility, high costs, and low interoperability. However, scholars have expressed extensive concerns about the sustainability of OS EHR. Recognizing that OSS project sustainability relies on their governance arrangements, this case study reports on the evolution of the governance and sustainability of a Japanese OS EHR project and provides rich insights to other open source EHR initiative stakeholders, including physicians, developers, researchers, and policy-makers.
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The dawning of the digital era in the management of hypertension. Hypertens Res 2020; 43:1135-1140. [PMID: 32655134 DOI: 10.1038/s41440-020-0506-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Awareness, treatment, and control of hypertension are of the utmost importance in conquering stroke and cardiovascular disease. To reduce the global burden of hypertension, the Japanese Society of Hypertension (JSH) established the "JSH Future Plan" based on an increasing need to transform the strategy for combating hypertension. In addition to energizing conventional approaches in basic, translational, and clinical research, the application of rapidly evolving digital health technologies and artificial intelligence to hypertension healthcare and research (digital hypertension) holds promise for providing further insights into the pathophysiology and therapeutic targets and implementing predictive, personalized, and preemptive approaches in clinical practice. With great potential to revolutionize the landscape of hypertension, digital hypertension has some technical, legal, ethical, social, and financial issues to overcome. Given the multidisciplinary framework, digital hypertension requires comprehensive and strategic collaboration among industry, academia, and government to move forward toward the goal of "Future Medicine".
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Li D, Chao J, Kong J, Cao G, Lv M, Zhang M. The efficiency analysis and spatial implications of health information technology: A regional exploratory study in China. Health Informatics J 2019; 26:1700-1713. [PMID: 31793803 DOI: 10.1177/1460458219889794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The new adoption of healthcare information technology is costly, and effects on healthcare performance can be questionable. This nationwide study in China investigated the efficient performance of healthcare information technology and examined its spatial correlation. Panel data were extracted from the Annual Investigation Report on Hospital Information in China and the China Health Statistics Yearbook for 2007 through 2015 (279 observations). Stochastic frontier analysis was employed to estimate the technical efficiency of healthcare information technology performance and related factors at the regional level. Healthcare information technology performance was positively associated with electronic medical records, total input, and cost of inpatient stay, while picture archiving and communication systems and net assets were negatively related. Local Indicators of Spatial Association showed that there existed significant spatial autocorrelation. Governmental policies would best make distinctions among different forms of healthcare information technology, especially between electronic medical records and picture archiving and communication systems. Policies should be formulated to improve healthcare information technology adoption and reduce regional differences.
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Affiliation(s)
| | | | | | - Gui Cao
- Renmin University of China, China
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Kawaguchi H, Koike S, Ohe K. Facility and Regional Factors Associated With the New Adoption of Electronic Medical Records in Japan: Nationwide Longitudinal Observational Study. JMIR Med Inform 2019; 7:e14026. [PMID: 31199307 PMCID: PMC6598416 DOI: 10.2196/14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background The rate of adoption of electronic medical record (EMR) systems has increased internationally, and new EMR adoption is currently a major topic in Japan. However, no study has performed a detailed analysis of longitudinal data to evaluate the changes in the EMR adoption status over time. Objective This study aimed to evaluate the changes in the EMR adoption status over time in hospitals and clinics in Japan and to examine the facility and regional factors associated with these changes. Methods Secondary longitudinal data were created by matching data in fiscal year (FY) 2011 and FY 2014 using reference numbers. EMR adoption status was defined as “EMR adoption,” “specified adoption schedule,” or “no adoption schedule.” Data were obtained for hospitals (n=4410) and clinics (n=67,329) that had no adoption schedule in FY 2011 and for hospitals (n=1068) and clinics (n=3132) with a specified adoption schedule in FY 2011. The EMR adoption statuses of medical institutions in FY 2014 were also examined. A multinomial logistic model was used to investigate the associations between EMR adoption status in FY 2014 and facility and regional factors in FY 2011. Considering the regional variations of these models, multilevel analyses with second levels were conducted. These models were constructed separately for hospitals and clinics, resulting in four multinomial logistic models. The odds ratio (OR) and 95% Bayesian credible interval (CI) were estimated for each variable. Results A total of 6.9% of hospitals and 14.82% of clinics with no EMR adoption schedules in FY 2011 had adopted EMR by FY 2014, while 10.49% of hospitals and 33.65% of clinics with specified adoption schedules in FY 2011 had cancelled the scheduled adoption by FY 2014. For hospitals with no adoption schedules in FY 2011, EMR adoption/scheduled adoption was associated with practice size characteristics, such as number of outpatients (from quantile 4 to quantile 1: OR 1.67, 95% CI 1.005-2.84 and OR 2.40, 95% CI 1.80-3.21, respectively), and number of doctors (from quantile 4 to quantile 1: OR 4.20, 95% CI 2.39-7.31 and OR 2.02, 95% CI 1.52-2.64, respectively). For clinics with specified EMR adoption schedules in FY 2011, the factors negatively associated with EMR adoption/cancellation of scheduled EMR adoption were the presence of beds (quantile 4 to quantile 1: OR 0.57, 95% CI 0.45-0.72 and OR 0.74, 95% CI 0.58-0.96, respectively) and having a private establisher (quantile 4 to quantile 1: OR 0.27, 95% CI 0.13-0.55 and OR 0.43, 95% CI 0.19-0.91, respectively). No regional factors were significantly associated with the EMR adoption status of hospitals with no EMR adoption schedules; population density was positively associated with EMR adoption in clinics with no EMR adoption schedule (quantile 4 to quantile 1: OR 1.49, 95% CI 1.32-1.69). Conclusions Different approaches are needed to promote new adoption of EMR systems in hospitals as compared to clinics. It is important to induce decision making in small- and medium-sized hospitals, and regional postdecision technical support is important to avoid cancellation of scheduled EMR adoption in clinics.
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Affiliation(s)
- Hideaki Kawaguchi
- Department of Biomedical Informatics, The University of Tokyo, Tokyo, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, The University of Tokyo, Tokyo, Japan
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Impact of electronic medical records (EMRs) on hospital productivity in Japan. Int J Med Inform 2018; 118:36-43. [DOI: 10.1016/j.ijmedinf.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
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