A cost-benefit analysis of electronic medical records in primary care

Wang, Samuel J.; Middleton, Blackford; Prosser, Lisa A.; Bardon, Christiana G.; Spurr, Cynthia; Carchidi, Patricia J.; Kittler, Anne F.; Goldszer, Robert C.; Fairchild, David G.; Sussman, Andrew J.; Kuperman, Gilad J.; Bates, David W.

doi:10.1016/s0002-9343(03)00057-3

Cited by 567 publications

(353 citation statements)

References 20 publications

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“…The benefits of current DSSs used in general practice include assisting doctors in performing diagnosis, disease prevention, enhancing decision making quality in the primary care consultation and in selecting appropriate dosage [19]. All these are in line with Wang et al's results of a 5-year study [20].…”

Section: Electronic Medical Record Systems and Decision Support Systesupporting

confidence: 64%

A hybrid knowledge-based approach to supporting the medical prescription for general practitioners: Real case in a Hong Kong medical center

Ting

Kwok

Tsang

et al. 2011

Knowledge-Based Systems

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ObjectiveWith the increased complexity and uncertainty in drug information, issuing medical prescriptions has become a vexing issue. As many as 240,000 medicines are available on the market, so this paper proposes a novel approach to the issuing of medical prescriptions. The proposed process will provide general practitioners (GPs) with medication advice and suggest a range of medicines for specific medical conditions by taking into consideration the collective pattern as well as the individual preferences of physicians' prescription decisions. Methods and MaterialA hybrid approach is described that uses a combination of case-based reasoning (CBR) and Bayesian reasoning. In the CBR process, all the previous knowledge retrieved via similarity measures is made available for the reference of physicians as to what medicines have been prescribed (to a particular patient) in the past. After obtaining the results from CBR, Bayesian reasoning is then applied to model the prescription experience of all physicians within the organization. By comparing the two sets of results, more refined recommendations on a range of medicines are suggested along with the ranking for each recommendation. ResultsTo validate the proposed approach, a Hong Kong medical center was selected as a testing site. Through application of the hybrid approach in the medical center for a period of one month, the results demonstrated that the approach produced satisfactory performance in terms of user satisfaction, ease of use, flexibility and effectiveness. In addition, the proposed approach yields better results and a faster learning rate than This is the Pre-Published Version. 2 when either CBR or Bayesian reasoning are applied alone. ConclusionEven with the help of a decision support system, the current approach to anticipating what drugs are to be prescribed is not flexible enough to cater for individual preferences of GPs, and provides little support for managing complex and dynamic changes in drug information. Therefore, with the increase in the amount of information about drugs, it is extremely difficult for physicians to write a good prescription. By integrating CBR and Bayesian reasoning, the general practitioners' prescription practices can be retrieved and compared with the collective prescription experience as modeled by probabilistic reasoning. As a result, physicians can select the drugs which are supported by informed evidential decisions. That is, they can take into consideration the pattern of decisions made by other physicians in similar cases.

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Section: Electronic Medical Record Systems and Decision Support Systesupporting

confidence: 64%

A hybrid knowledge-based approach to supporting the medical prescription for general practitioners: Real case in a Hong Kong medical center

Ting

Kwok

Tsang

et al. 2011

Knowledge-Based Systems

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“…9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care practices and offer little or no patient care benefi ts. 8 Because primary care practices are complex adaptive systems interconnected with many other organizations and made up of individuals with widely varying educational backgrounds, processes and outcomes of organizational change are largely unpredictable. 11,12 In these complex systems, the interactions between participants are nonlinear in that the behavior of the whole is not simply the sum of the behaviors of all of the participants.…”

mentioning

confidence: 99%

“…7 In addition, using an EMR that includes electronic prescribing as well as electronic charting offers substantial fi nancial benefi ts to primary care organizations and the health system as a whole. 8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy.…”

mentioning

confidence: 99%

“…8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the organization.…”

mentioning

confidence: 99%

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Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

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PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the fi nancial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine offi ce culture affect the initial implementation of an EMR. METHODSAs part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data.RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal confl icts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an offi ce practice and without methods for bringing to the surface and addressing confl icts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs. INTRODUCTIONB oth the Institute of Medicine and the Future of Family Medicine project have recommended the use of information technologies and electronic medical record (EMR) systems as tools for improving the quality of care 1 and patient safety. 2,3 Recent research has shown that information technologies can reduce medication errors, 4 improve adherence to clinical practice guidelines, 5 and improve the delivery of preventive health services, 6 thereby potentially improving health outcomes for patients. 7 In addition, using an EMR that includes electronic prescribing as well as electronic charting offers substantial fi nancial benefi ts to primary care organizations and the health system as a whole. 8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care pr...

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“…Previous studies [2] have demonstrated that it is possible to improve patient's care and save time and space using electronic reports in contrast with traditional paper ones. The use of simple tools allows removing the principal barriers of Information Technology systems, that is the implementation of too complex tools that require technical knowledge from users [3] [4].…”

Section: Introductionmentioning

confidence: 99%

Electronic Report Generation Web Service evaluated within a Telemedicine System

et al. 2009

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Abstract-This work presents a generic tool based on a client-server architecture that generates electronic reports helping the evaluation process of any information system. For the specific evaluation of telemedicine systems the defined reports cover four dimensions: auditory of the system; evolution of clinical protocols; results from the questionnaires for user acceptance and quality of life; and surveillance of clinical variables. The use of a Web Service approach allows multiplatform use of the developed electronic report service and the modularity followed in the implementation enables easy system evolution and scalability.

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A cost-benefit analysis of electronic medical records in primary care

Cited by 567 publications

References 20 publications

A hybrid knowledge-based approach to supporting the medical prescription for general practitioners: Real case in a Hong Kong medical center

A hybrid knowledge-based approach to supporting the medical prescription for general practitioners: Real case in a Hong Kong medical center

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Electronic Report Generation Web Service evaluated within a Telemedicine System

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