School of Medicine, Pharmacy and Health, University of Durham, Stockton-on-Tees, UK The Center for Patient Safety Research and Practice, Division of General Internal Medicine, The Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
PRMA Consulting Ltd, Fleet, UK.
J Am Med Inform Assoc. 2014 Oct;21(e2):e226-31. doi: 10.1136/amiajnl-2013-002404. Epub 2014 Feb 12.
We conducted a prospective evaluation of different forms of electronic health record (EHR) systems to better understand the costs incurred during implementation and the factors that can influence these costs.
We selected a range of diverse organizations across three different geographical areas in England that were at different stages of implementing three centrally procured applications, that is, iSOFT's Lorenzo Regional Care, Cerner's Millennium, and CSE's RiO. 41 semi-structured interviews were conducted with hospital staff, members of the implementation team, and those involved in the implementation at a national level.
Four main overarching cost categories were identified: infrastructure (eg, hardware and software), personnel (eg, training team), estates/facilities (eg, space), and other (eg, training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure, diverse training approaches for staff, and different software applications to integrate with the new system.
Improving the quality and safety of patient care through EHR adoption is a priority area for UK and US governments and policy makers worldwide. With cost considered one of the most significant barriers, it is important for hospitals and governments to be clear from the outset of the major cost categories involved and the factors that may impact on these costs. Failure to adequately train staff or to follow key steps in implementation has preceded many of the failures in this domain, which can create new safety hazards.
我们对不同形式的电子健康记录（EHR）系统进行了前瞻性评估，以更好地了解实施过程中产生的成本，以及可能影响这些成本的因素。
我们选择了英格兰三个不同地理区域的一系列不同组织，这些组织处于实施三种集中采购应用程序的不同阶段，即 iSOFT 的 Lorenzo 区域护理、Cerner 的 Millennium 和 CSE 的 RiO。对医院工作人员、实施团队成员以及在国家一级参与实施的人员进行了 41 次半结构化访谈。
确定了四个主要的总体成本类别：基础设施（例如硬件和软件）、人员（例如培训团队）、房地产/设施（例如空间）和其他（例如培训材料）。许多因素被认为会影响这些成本，不同的医院选择了不同数量和类型的基础设施、不同的员工培训方法，以及不同的软件应用程序来与新系统集成。
通过采用电子健康记录来提高患者护理的质量和安全性是英国和美国政府以及全球政策制定者的优先事项。由于成本被认为是最大的障碍之一，因此医院和政府从一开始就清楚地了解所涉及的主要成本类别以及可能影响这些成本的因素非常重要。未能充分培训员工或未能遵循实施的关键步骤，这在该领域的许多失败中都有先例，这可能会带来新的安全隐患。
