Lynn Johnson is Professor and Associate Dean, University of Michigan School of Dentistry; Cassandra Callaghan is Director of Dental Informatics, University of Michigan School of Dentistry; Madhan Balasubramanian is Sidney Sax National Health and Medical Research Council Research Fellow, University of Sydney, Australia and King's College London, United Kingdom; Haris Haq is a Consultant, Collaboration for Health IT; and Heiko Spallek is Professor, Head of School, and Dean, The University of Sydney School of Dentistry, Sydney, New South Wales, Australia.
J Dent Educ. 2019 Aug;83(8):895-903. doi: 10.21815/JDE.019.089. Epub 2019 Apr 22.
Electronic health records (EHRs) are increasingly moving towards cloud-based web environments. While cloud-based EHRs claim substantial benefits at reduced cost, little cost-benefit research exists for dental schools. The aim of this study was to examine the cost-benefits of a cloud-based EHR compared to an on-premise client-server EHR in the University of Michigan School of Dentistry (U-M Dent). Data were collected in 2016 from the U-M Dent cost-benefit comparison of tangible and intangible factors associated with implementing a new EHR, using the Total Cost of Ownership (TCO) framework from EDUCAUSE. The TCO framework assessed three factors: foundational (overarching aspects: three items), qualitative (intangibles: 56 items), and quantitative (actual costs). Stakeholders performed factor grading, and relative assessment scores were derived for each item as well as the overall factor. The cloud-based EHR solution received higher foundational and qualitative factor summary scores. The overall cost of an on-premise solution over a two-year period was approximately $2,000,000 higher than a cloud-based solution. Cloud solutions did not carry any hidden costs, while such costs accounted for 8% (~$540,000) of the overall costs of the on-premise solution. Across the two-year period, both one-time and ongoing costs were higher for the on-premise solution than the cloud-based solution (by 40.5% and 20.5%, respectively). This study found that a cloud-based EHR system in the U-M Dent offered significant cost savings and unique benefits that were not available with the on-premise EHR solution. Based on cost, the U-M Dent has made a case for cloud-based EHR systems.
电子健康记录 (EHR) 越来越多地向基于云的网络环境转移。虽然基于云的 EHR 在降低成本方面声称具有实质性的好处，但牙科学校的成本效益研究很少。本研究旨在比较密歇根大学牙科学院 (U-M Dent) 基于云的 EHR 与基于客户端-服务器的传统 EHR 的成本效益。2016 年，从密歇根大学牙科学院与实施新 EHR 相关的有形和无形因素的成本效益比较中收集数据，使用 EDUCAUSE 的总体拥有成本 (TCO) 框架。TCO 框架评估了三个因素：基础（总体方面：三个项目）、定性（无形：56 个项目）和定量（实际成本）。利益相关者对因素进行了评分，并为每个项目以及整个因素得出了相对评估分数。基于云的 EHR 解决方案在基础和定性因素汇总得分方面得分更高。在两年期间，基于客户端-服务器解决方案的总成本比基于云的解决方案高出约 200 万美元。云解决方案没有任何隐藏成本，而这些成本占基于客户端-服务器解决方案总成本的 8%（约 54 万美元）。在两年期间，基于客户端-服务器解决方案的一次性和持续成本都高于基于云的解决方案（分别为 40.5%和 20.5%）。本研究发现，U-M Dent 的基于云的 EHR 系统提供了显著的成本节约和基于客户端-服务器的 EHR 解决方案所没有的独特优势。基于成本，U-M Dent 已为基于云的 EHR 系统提出了理由。
