Takura Tomoyuki, Itoh Haruki
Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo Tokyo Japan.
Sakakibara Heart Institute Hospital and Clinics Tokyo Japan.
Circ Rep. 2019 Sep 5;1(9):355-360. doi: 10.1253/circrep.CR-19-0028.
Because electronic medical record systems may affect productivity of clinical practice, we examined the effects of different types of medical record systems on consultation time and total fee claims for outpatient consultation for cardiovascular cases. We investigated consultation time (i.e., the sum of practice time and work-up time) and total fee claims by 13 cardiovascular physicians for 862 outpatients. The means of consultation time and total fee claims were calculated for 3 types of medical records: electronic, paper-based, and hybrid. No difference in mean consultation time was seen between the electronic and paper-based medical record groups (paper based, 11.4±0.3 min/case; electronic, 12.7±0.8 min/case; hybrid, 13.5±0.5 min/case). In contrast, the electronic group had the highest mean practice time (10.9±0.6 min/case) and the lowest mean work-up time (1.7±0.4 min/case). There was no difference in total fee claims between the 3 medical record groups. The total fee claims per practice time was lower for the electronic group than the paper-based (67.5±52.8 vs. 108.8±108.1 points/min, P<0.001). The findings suggest that physicians using the electronic medical record system can be more directly involved with patients due to higher productivity, as reflected in the lower work-up time.
由于电子病历系统可能会影响临床实践的工作效率，我们研究了不同类型的病历系统对心血管疾病门诊会诊时间和总费用报销的影响。我们调查了13位心血管内科医生为862名门诊患者提供会诊的时间（即诊疗时间和检查时间之和）以及总费用报销情况。计算了电子病历、纸质病历和混合病历3种类型病历的会诊时间均值和总费用报销均值。电子病历组和纸质病历组的平均会诊时间没有差异（纸质病历组，11.4±0.3分钟/病例；电子病历组，12.7±0.8分钟/病例；混合病历组，13.5±0.5分钟/病例）。相比之下，电子病历组的平均诊疗时间最长（10.9±0.6分钟/病例），平均检查时间最短（1.7±0.4分钟/病例）。3种病历组的总费用报销没有差异。电子病历组每诊疗时间的总费用报销低于纸质病历组（67.5±52.8对108.8±108.1分/分钟，P<0.001）。研究结果表明，使用电子病历系统的医生由于工作效率较高，如检查时间较短，因此可以更直接地接触患者。
