Langabeer James R, Walji Muhammad F, Taylor David, Valenza John A
Houston, School of Public Health, 1200 Herman Pressler, Suite RAS E-341, Houston TX 77030, USA.
J Dent Educ. 2008 Oct;72(10):1189-200.
The implementation of an electronic patient record (EPR) in many sectors of health care has been suggested to have positive relationships with both quality of care and improved pedagogy, although evaluation of actual results has been somewhat disillusioning. Evidence-based dentistry clearly suggests the need for tools and systems to improve care, and an EPR is a critical tool that has been widely proposed in recent years. In dental schools, EPR systems are increasingly being adopted, despite obstacles such as high costs, time constraints necessary for process workflow change, and overall project complexity. The increasing movement towards cost-effectiveness analyses in health and medicine suggests that the EPR should generally cover expenses, or produce total benefits greater than its combined costs, to ensure that resources are being utilized efficiently. To test the underlying economics of an EPR, we utilized a pre-post research design with a probability-based economic simulation model to analyze changes in performance and costs in one dental school. Our findings suggest that the economics are positive, but only when student fees are treated as an incremental revenue source. In addition, other performance indicators appeared to have significant changes, although most were not comprehensively measured pre-implementation, making it difficult to truly understand the performance differential-such pre-measurement of expected benefits is a key lesson learned. This article also provides recommendations for dental clinics and universities that are about to embark on this endeavor.
在医疗保健的许多领域推行电子病历（EPR），被认为与医疗质量的提升以及教学方法的改进都存在积极关联，尽管对实际效果的评估结果有些令人失望。循证牙科明确表明需要借助工具和系统来改善医疗服务，而电子病历是近年来被广泛提议采用的关键工具。在牙科院校，尽管存在诸如成本高昂、流程工作流变更所需的时间限制以及项目整体复杂性等障碍，但电子病历系统仍越来越多地被采用。医疗卫生和医学领域对成本效益分析的关注度日益提高，这意味着电子病历通常应能覆盖相关费用，或者产生大于其综合成本的总体效益，以确保资源得到有效利用。为了检验电子病历的潜在经济学原理，我们采用了前后对照研究设计，并结合基于概率的经济模拟模型，来分析一所牙科院校在绩效和成本方面的变化。我们的研究结果表明，从经济学角度来看是积极的，但前提是要将学生费用视为增量收入来源。此外，其他绩效指标似乎也有显著变化，不过在实施前大多未进行全面衡量，这使得难以真正理解绩效差异——对预期效益进行这种预先衡量是我们吸取的一个关键教训。本文还为即将开展此项工作的牙科诊所和大学提供了建议。
