Chen Cynthia, Sukmanee Jarawee, Soon Khai Wee, Lim Julian, D'Souza Jared Louis Andre, Teerawattananon Yot
Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore.
Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, United States.
J Med Internet Res. 2025 Jun 11;27:e70484. doi: 10.2196/70484.
With the vast development of technology and the evolving needs of patients and health care providers, electronic medical records (EMRs) have become a cornerstone for health information. However, different institutions have used different EMR systems. Our study investigates the potential benefits of implementing an integrated and common platform, known as the Next Generation Electronic Medical Record (NGEMR) in Singapore. The NGEMR allows improved data sharing between health care facilities and can promote better coordination between primary care and specialist care doctors to access patients' records from the same database.
This study aims to conduct an economic evaluation of the NGEMR to inform future health care system upgrades.
A cost-utility analysis comparing NGEMR with the legacy EMR was conducted using a decision tree model with a 1-year time horizon from a health care system perspective. Input parameters of patients visiting primary care at the National University Polyclinics and specialist outpatient clinics from a General Hospital were extracted from the EMR systems. The incremental cost-effectiveness ratio (ICER) was calculated using costs and quality-adjusted life years (QALYs).
NGEMR was cost-effective and yielded a marginal health benefit (0.00006 QALYs gained) at a slightly higher cost (S $2.73; US $2.02), with an ICER of S $46,349 (US $34,298) per QALY. At the willingness-to-pay thresholds of 0.5- and 1-time gross domestic product (GDP) per capita (S $48,899; US $36,185 and S $97,798; US $72,371 per QALY), the implementation of NGEMR had a 52.2% and 64.7% probability of being cost-effective, respectively. The reduction in waiting time to see a specialist resulted in 2.3% fewer hospitalizations. The most influential parameter on the ICER was the probability of receiving duplicate tests, followed by the costs of admission and the probability of seeing a specialist. Reducing the probability of receiving duplicate tests for NGEMR from 20.7% to 13.2% resulted in a cost-saving ICER. A threshold analysis on the proportion of patients with a waiting time of less than 20 days for NGEMR was further explored, as it was a sensitive parameter on the cost-effectiveness of NGEMR. Increasing the proportion of patients with a waiting time of less than 20 days from 45.5% to 56% would result in cost savings for NGEMR.
The adoption of NGEMR is cost-effective in Singapore. Beyond cost-effectiveness, the reduction of waiting time between primary and specialist care can lower the possibility of patients' health deterioration, thus reducing hospital admissions. We recommend continuous monitoring of waiting times and the likelihood of having duplicate tests as countries transition from basic to advanced-level EMR systems. Future analyses could benefit from more granular data on timing and clinical indications and incorporate real-world local data as they become available through ongoing NGEMR rollout evaluations.
随着技术的飞速发展以及患者和医疗服务提供者需求的不断演变，电子病历（EMR）已成为健康信息的基石。然而，不同机构使用的是不同的电子病历系统。我们的研究调查了在新加坡实施一个集成的通用平台（即下一代电子病历，NGEMR）的潜在益处。NGEMR能够改善医疗机构之间的数据共享，并能促进初级保健医生和专科医生之间更好地协作，以便从同一个数据库访问患者记录。
本研究旨在对NGEMR进行经济评估，为未来医疗系统升级提供参考。
从医疗系统角度出发，使用决策树模型，以1年为时间跨度，对NGEMR与传统电子病历进行成本效用分析。从国立大学综合诊所的初级保健和综合医院专科门诊就诊患者的电子病历系统中提取输入参数。使用成本和质量调整生命年（QALY）计算增量成本效益比（ICER）。
NGEMR具有成本效益，在成本略高（2.73新加坡元；2.02美元）的情况下产生了边际健康效益（获得0.00006个QALY），ICER为每QALY 46,349新加坡元（34,298美元）。在人均国内生产总值（GDP）的0.5倍和1倍支付意愿阈值（每QALY 48,899新加坡元；36,185美元和97,798新加坡元；72,371美元）下，实施NGEMR分别有52.2%和64.7%的概率具有成本效益。专科就诊等待时间的缩短使住院率降低了2.3%。对ICER影响最大的参数是接受重复检查的概率，其次是住院费用和看专科医生的概率。将NGEMR接受重复检查的概率从20.7%降至13.2%会带来成本节约的ICER。进一步探讨了NGEMR等待时间少于20天的患者比例的阈值分析，因为这是一个对NGEMR成本效益敏感的参数。将等待时间少于20天的患者比例从45.5%提高到56%将为NGEMR带来成本节约。
在新加坡采用NGEMR具有成本效益。除了成本效益外，初级保健和专科保健之间等待时间的减少可以降低患者健康恶化的可能性，从而减少住院率。我们建议在各国从基础电子病历系统向高级电子病历系统过渡时，持续监测等待时间和重复检查的可能性。未来的分析可以受益于关于时间安排和临床指征的更详细数据，并纳入随着NGEMR持续推广评估而获得的实际本地数据。
