Bruland Philipp, Forster Christian, Breil Bernhard, Ständer Sonja, Dugas Martin, Fritz Fleur
Institute of Medical Informatics, University of Münster, Germany.
Department of Information Systems, University of Münster, Germany.
Int J Med Inform. 2014 Dec;83(12):915-28. doi: 10.1016/j.ijmedinf.2014.08.007. Epub 2014 Aug 29.
The first objective of this study is to evaluate the impact of integrating a single-source system into the routine patient care documentation workflow with respect to process modifications, data quality and execution times in patient care as well as research documentation. The second one is to evaluate whether it is cost-efficient using a single-source system in terms of achieved savings in documentation expenditures.
We analyzed the documentation workflow of routine patient care and research documentation in the medical field of pruritus to identify redundant and error-prone process steps. Based on this, we established a novel documentation workflow including the x4T (exchange for Trials) system to connect hospital information systems with electronic data capture systems for the exchange of study data. To evaluate the workflow modifications, we performed a before/after analysis as well as a time-motion study. Data quality was assessed by measuring completeness, correctness and concordance of previously and newly collected data. A cost-benefit analysis was conducted to estimate the savings using x4T per collected data element and the additional costs for introducing x4T.
The documentation workflow of patient care as well as clinical research was modified due to the introduction of the x4T system. After x4T implementation and workflow modifications, half of the redundant and error-prone process steps were eliminated. The generic x4T system allows direct transfer of routinely collected health care data into the x4T research database and avoids manual transcription steps. Since x4T has been introduced in March 2012, the number of included patients has increased by about 1000 per year. The average entire documentation time per patient visit has been significantly decreased by 70.1% (from 1116±185 to 334±83 s). After the introduction of the x4T system and associated workflow changes, the completeness of mandatory data elements raised from 82.2% to 100%. In case of the pruritus research study, the additional costs for introducing the x4T system are €434.01 and the savings are 0.48ct per collected data element. So, with the assumption of a 5-year runtime and 82 collected data elements per patient, the amount of documented patients has to be higher than 1102 to create a benefit.
Introduction of the x4T system into the clinical and research documentation workflow can optimize the data collection workflow in both areas. Redundant and cumbersome process steps can be eliminated in the research documentation, with the result of reduced documentation times as well as increased data quality. The usage of the x4T system is especially worthwhile in a study with a large amount of collected data or a high number of included patients.
本研究的首要目标是评估将单一来源系统集成到常规患者护理文档工作流程中，在患者护理及研究文档方面对流程修改、数据质量和执行时间的影响。第二个目标是从文档支出的节省情况来评估使用单一来源系统是否具有成本效益。
我们分析了瘙痒症医学领域常规患者护理和研究文档的文档工作流程，以识别冗余和易出错的流程步骤。在此基础上，我们建立了一种新颖的文档工作流程，包括x4T（试验数据交换）系统，用于连接医院信息系统和电子数据采集系统以交换研究数据。为了评估工作流程的修改，我们进行了前后分析以及时间动作研究。通过测量先前和新收集数据的完整性、正确性和一致性来评估数据质量。进行了成本效益分析，以估计使用x4T每个收集的数据元素节省的费用以及引入x4T的额外成本。
由于引入了x4T系统，患者护理以及临床研究的文档工作流程得到了修改。在实施x4T和修改工作流程后，消除了一半冗余和易出错的流程步骤。通用的x4T系统允许将常规收集的医疗保健数据直接传输到x4T研究数据库中，并避免了手动转录步骤。自2012年3月引入x4T以来，每年纳入的患者数量增加了约1000例。每次患者就诊的平均整个文档记录时间显著减少了70.1%（从1116±185秒降至334±83秒）。引入x4T系统及相关工作流程变更后，强制数据元素的完整性从82.2%提高到了100%。在瘙痒症研究中，引入x4T系统的额外成本为434.01欧元，每个收集的数据元素节省0.48欧分。因此，假设运行5年且每位患者收集82个数据元素，记录的患者数量必须高于1102例才能产生效益。
将x4T系统引入临床和研究文档工作流程可以优化这两个领域的数据收集工作流程。研究文档中可以消除冗余和繁琐的流程步骤，从而减少文档记录时间并提高数据质量。在收集大量数据或纳入大量患者的研究中，使用x
