Park Young-Taek, Kim Donghwan, Park Rae Woong, Atalag Koray, Kwon In Ho, Yoon Dukyong, Choi Mona
Department of Information and Communication Technology, Health Insurance Review and Assessment Service, Wonju, Korea.
Research Institute for Health Insurance Review and Assessment, Health Insurance Review and Assessment Service, Wonju, Korea.
Healthc Inform Res. 2020 Jan;26(1):68-77. doi: 10.4258/hir.2020.26.1.68. Epub 2020 Jan 31.
We investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data.
The study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted.
We found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only ( = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, = 0.001).
The findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research.
我们调查了医疗保健机构（HCOs）全面采用电子病历（EMR）系统与药物使用之间的关联，以探讨诸如电子处方、药物重整和决策支持等EMR系统功能是否可能与药物使用相关，为此我们使用了全国范围的相关数据。
本研究设计为横断面研究。2013年11月至2014年1月期间，在韩国收集了经济合作与发展组织基准信息通信技术（ICT）研究中EMR系统采用水平的调查数据。调查对象为医院首席信息官和基层医疗诊所的医生。从国家医疗保险行政数据集中提取了两个结果，即抗生素处方率和使用≥6种药物的多重用药情况。
我们发现，与仅在医院采用纸质病历的部分采用情况相比，全面采用EMR的抗生素药物处方率低16.1%（P = 0.041）。在EMR采用状态与多重用药处方之间，只有那些全面采用EMR的诊所与更高的多重用药处方存在显著关联（36.9%，P = 0.001）。
研究结果表明可能存在一些混杂效应，尽管结果好坏参半，但先进的ICT可能会给医疗质量带来一些益处。虽然全面采用EMR系统与抗生素药物使用之间的负相关仅在医院中显著，但EMR系统的药物搜索功能或列出特定患者清单可能有助于减少抗生素药物的使用。全面采用EMR系统与综合医院和诊所（而非医院）的多重用药率之间的正相关关系需要进一步研究。
