Analysis of cost and assessment of computerized patient record systems in Japan based on questionnaire survey

• HIT Description: EHR More info...
  
• Purpose of Study: to clarify the implementation and maintenance costs of a computerized patient record system
  
• Years of study: 2003
  
• Study Design: questionnaire survey mailed out to hospitals that have already started using a CPR system in Japan
  
• Outcomes: per-bed mean cost for CPR implementation; mean annual maintenance cost; relationships between implementation cost and the CPR system make, number of servers, institution type, and implementation date; respondents' satisfaction with the CPR system; respondents' perceptions of the im
  

• Settings: all 81 hospitals in Japan that had installed a computerized patient record (CPR) system (according to 2002 Medical Devices & System Databook) were sent survey questionnaire; 41 (51%) hospitals responded; 33 (41%) met the CPR system criteria (described in HIT system description bullet) were instal
• Intervention: none
• Evaluation Method: self-reported questionnaire survey by mail; Hayashi's Quantification Type I was used to determine the individual influence of the four factors on per-bed implementation cost: system maker, size of system, implementation date, and institution type
• Description: 1) the CPR system was used for both out and inpatients; 2) if leasing, the CPR systems was leased for 5 years or longer; and 3) if purchase, the purchased CPR systems had been in operation for 5 years or more
• Barriers: confusion when the CPR system was first installed; poor user-friendliness raised users' stress levels; reaching a consensus on whether or not to install a CPR system was difficult; learning and research to master the CPR system increased staff work load;
• HIT System Sustainability: the CPR system had been in operation for at least 5 years
• Extrinsic Factors in valuing cost and benefits: In 1999, the ministry of Health, Labor and Welfare in Japan authorized computerization of medical records. The goal is by 2006, 60% of all hospitals with 400 or more beds and 60% of all clinics will have a CPR system.
• Cost of Implementation: per-bed mean cost, CPR system - $14,308 (range $3538 - $38077); by hospital size as follow - $19K for 200 beds; $10,154 for 200 499 beds; $16,462 for >= 500 beds; the implementation cost was 3% of annual revenue of hospitals with 200 beds; 1% for hospitals >= 500 beds; 4 factors strongly impacted per-bed implementation cost: maker of CPR system, number of serv
• Long-term Cost: mean annual maintenance cost for a CPR system was $457,615 (ranging from $39,769 to $2,307,692); the mean percentage of annual maintenance costs against total implementation cost was 9% regardless of the size of hospitals (although
• Quality of Care and Patient Safety Outcome: 82% of hospitals responded positively that CPR systems imporve the quality of medical care; 70% felt that the systems help prevent medical errors
• Benefits: by respondent self-report
• Changes in healthcare costs: respondents were split roughly equally regarding cost reduction (yes, no, undecided)
• Changes in efficiency and productivity: the majority of the hospitals responded positively regarding improved hospital administration, smoother medical examinations, easier to fetch and understand medical information and saved time.