Yasunaga Hideo, Imamura Tomoaki, Yamaki Shintaro, Endo Hiroyoshi
Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Int J Med Inform. 2008 Oct;77(10):708-13. doi: 10.1016/j.ijmedinf.2008.03.005. Epub 2008 Apr 29.
The present study reports the current status of computerizing medical records in Japan. In 2001, the Ministry of Health, Labour and Welfare formulated the Grand Design for the Development of Information Systems in the Healthcare and Medical Fields. The Grand Design stated a numerical target for "spreading the use of electronic medical records (EMR) in at least 60% of Japan's hospitals with 400 or more beds by 2006." The objective of this study was to examine the extent to which EMR and order entry systems (OES) have been adopted as of February 2007 and to evaluate the Japanese government's policy regarding the computerization of medical records.
We conducted a postal survey targeting medical institutions throughout Japan. In February 2007, we mailed self-administered questionnaires to all 1574 hospitals with 300 or more beds, and to a random selection of 1000 hospitals with less than 300 beds in addition to 4000 clinics. Responses were received from 812 (51.6%), 504 (50.5%), and 1769 (44.8%), respectively. We asked questions concerning: (i) the extent to which EMR and OES had been introduced; (ii) the reasons why certain institutions had not introduced EMR and (iii) the subjective evaluation of the efficacy and cost-effectiveness of EMR.
The percentage of institutions that had introduced EMR as of February 2007 was 10.0% for hospitals and 10.1% for clinics. Even the percentage for hospitals with 400 or more beds was just 31.2%, illustrating that the government's target had not been reached. The most common reason given for not introducing EMR was: "The cost is high" which was observed in 82.0% of hospitals. It was considered that the introduction of EMR could improve 'inter-hospital networks', and 'time efficiency for physicians' by around 45% and 25% of hospitals, respectively.
Healthcare information computerization in Japan is behind schedule because the introductory costs are high. For the computerization of healthcare information to be further promoted, prices of EMR systems should be lowered to a level which individual hospitals can afford. Furthermore, the communication between EMR systems should be further standardized to secure functional and semantic interoperability in Japan.
本研究报告了日本医疗记录计算机化的现状。2001年，厚生劳动省制定了医疗保健和医疗领域信息系统发展的总体设计。总体设计提出了一个量化目标，即“到2006年，在日本至少60%的拥有400张及以上床位的医院推广使用电子病历（EMR）”。本研究的目的是调查截至2007年2月EMR和医嘱录入系统（OES）的采用程度，并评估日本政府关于医疗记录计算机化的政策。
我们针对日本各地的医疗机构进行了邮寄调查。2007年2月，我们向所有1574家拥有300张及以上床位的医院以及随机抽取的1000家床位少于300张的医院和4000家诊所邮寄了自填式问卷。分别收到了812份（51.6%）、504份（50.5%）和1769份（44.8%）回复。我们询问了以下问题：（i）EMR和OES的引入程度；（ii）某些机构未引入EMR的原因；（iii）对EMR功效和成本效益的主观评价。
截至2007年2月，引入EMR的机构比例在医院中为10.0%，在诊所中为10.1%。即使是拥有400张及以上床位的医院，这一比例也仅为31.2%，说明政府的目标未实现。未引入EMR最常见的原因是：“成本高昂”，82.0%的医院都提到了这一点。约45%的医院认为引入EMR可以改善“医院间网络”，约25%的医院认为可以提高“医生的时间效率”。
由于引入成本高昂，日本的医疗保健信息计算机化落后于计划。为了进一步推动医疗保健信息的计算机化，EMR系统的价格应降至各医院能够承受的水平。此外，应进一步规范EMR系统之间的通信，以确保日本国内在功能和语义上的互操作性。
