Medical Corps, Israel Defense Forces, Tel Aviv, Israel.
J Am Med Inform Assoc. 2013 Jun;20(e1):e17-20. doi: 10.1136/amiajnl-2012-001504. Epub 2013 Mar 5.
Health information technology, especially electronic health records (EHRs), can be used to improve the efficiency and effectiveness of healthcare providers. This study assessed the cost-savings of incorporating a list of preferred specialty care providers into the EHRs used by all primary care physicians (PCPs), accompanied by a comprehensive implementation plan.
On January 1, 2005, all specialty clinic providers at the Israeli Defense Forces were divided into one of four financial classes based on their charges, class 1, the least expensive, being the most preferred, followed by classes 2-4. This list was incorporated into the EHRs used by all PCPs in primary care clinics. PCPs received comprehensive training. Target referral goals were determined for each class and measured for 4 years, together with the total cost of all specialist visits in the first year compared to the following years. Quality assessment (QA) scores were used as a measure of the program's effect on the quality of patient care.
During 2005-2008, a marginally significant decline in referrals to class 1 was observed (r=-0.254, p=0.078), however a significant increase in referral rates to class 2 was observed (r=0.957, p=0.042), concurrent with a decrease in referral rates to classes 3 and 4 (r=-0.312, p=0.024). An inverse correlation was observed between year and total costs for all visits to specialists (2008 prices; r=-0.96, p=0.04), and between the mean cost of one specialist visit over the 4 years, indicating a significant reduction in real costs (2008 prices; r=-0.995, p=0.005). QA was not affected by these changes (r=0.94, p=0.016).
From a policy perspective, our data suggest that EHR can facilitate effective utilization of healthcare providers and decrease costs.
医疗信息技术，尤其是电子健康记录（EHRs），可以用于提高医疗服务提供者的效率和效果。本研究评估了将首选专科医生列表纳入所有初级保健医生（PCPs）使用的 EHR 中所带来的成本节约，同时还制定了全面的实施计划。
2005 年 1 月 1 日，根据收费情况，将以色列国防军的所有专科诊所提供者分为四类，其中 1 类费用最低，最受欢迎，其次是 2-4 类。该列表被纳入所有初级保健诊所中 PCP 使用的 EHR 中。PCPs 接受了全面的培训。确定了每个类别目标转诊目标，并在 4 年内进行了测量，同时还比较了第一年与随后几年的所有专科就诊总费用。质量评估（QA）分数被用作衡量该计划对患者护理质量影响的指标。
在 2005-2008 年期间，观察到向第 1 类转诊的比例略有下降（r=-0.254，p=0.078），但向第 2 类转诊的比例显著增加（r=0.957，p=0.042），同时向第 3 类和第 4 类转诊的比例下降（r=-0.312，p=0.024）。所有专科就诊的总费用与年份之间存在负相关（2008 年价格；r=-0.96，p=0.04），4 年内每位专科医生就诊的平均费用也呈负相关，表明实际成本显著降低（2008 年价格；r=-0.995，p=0.005）。QA 不受这些变化的影响（r=0.94，p=0.016）。
从政策角度来看，我们的数据表明 EHR 可以促进医疗服务提供者的有效利用并降低成本。
