The only job left is to scan the signed consent forms into the EMR system. Registered nurses in charge of the outpatient care floors showed that there were also 11 clerks fully dedicated to the management of the paper-charts, and they were laid off after the EMR adoption.
It was very difficult to calculate the number of clerks on the outpatient care floors because the management of paper-charts on the floor was usually shared by all of the clerks. The registered nurses expressed that there were about 20 separate outpatient care areas, but only 11 clerks were moved to another department or did not have their contracts renewed. It is also conservative in that it did not consider the expansion of a building with about 10 outpatient care floors. The MDIS has saved supplies for medical devices such as A4-size paper, photographic paper, and roll-paper.
The yearly cost reductions were proportional to the number of interfaced devices. Among the benefits, additional revenues have been recognized from the paper-chart storage areas. The indoor storage was remodeled into clinic rooms for outpatient examinations. After adoption of the EMR system, 5 paper-chart temporary storage rooms on the outpatient care floors were also converted to clinic rooms.
In this case, the contribution of the remodeled space to revenue was 4. This study also found that the MT assistance also contributed to the growth of the number of outpatients per examination session.
The direct costs for the EMR applications and the system infrastructure were These 3 items covered Among benefits, additional revenue from MT support was also the largest at The reduction of chart management FTEs contributed The additional revenues incurred from remodeling of paper-chart storage areas accounted for 9.
These 3 items also covered Both the costs and the benefits are largely influenced by the MT support, which was introduced to smooth EMR adoption.
Scaning the existing paper-charts and storing them in the EMR system allowed the remodeling of the storage rooms into outpatient examination rooms. The benefits from this remodeling were also a large proportion of the total benefits. Looking at these results, the combination of the MT support and scanning the existing paper-charts could lead to different results. Therefore, this study attempted a case analysis with these 2 items.
In other cases, one of these might be excluded or both might be excluded. Thus, 3 additional cases were used for the economic evaluation Table 4. If a 5-year analysis period would have been applied, the cumulative NPV would have been under 0. However, the cumulative NPV based on an 8-year analysis is greater than 0. Thus, the EMR system can be financially cost-effective, but only if it is used for at least 4 or 5 years after full implementation.
The most cost-effective choice would have been investing in a simple transition from the paper-charts to the EMR system. Without scanning the existing paper-charts and the MT assistance, the cost would have been much lower.
The DPP in this simple transition would have been 5. It is a very meaningful economic evaluation in that this study performed a formal CBA using actual cash flows of tangible costs and benefits based on differential costs, which is useful for decision making in managerial accounting, in contrast to previous studies that have been based on potential factors.
As the previous studies mentioned, the biggest barriers to EMR adoption in hospitals are capital investment and high maintenance costs. Unfortunately, this study also revealed the same problem [ 7 - 11 ].
However, there is some comfort in that an analysis based on an 8-year study showed EMR to be financially cost-effective, because the cumulative NPV was greater than 0. Analysis covering a 5-year period after full deployment of the EMR system showed positive cash flow.
Compared to other industries, it takes much longer to deploy IT systems in the health care industry. The health care industry also tends to use systems for longer periods of time, usually more than 5 years. It is also true that there are various hard-to-quantify benefits that the EMR system contributes. If future research discovers more detailed benefits, such as the elimination of additional FTEs, the economic justification for the EMR system will be more supported. One interesting finding is that the overall costs were increased as the IT paradox, since the induced costs were included for a smooth EMR adoption [ 16 ].
However, with careful consideration, it was found that the costs for a simple transition from paper-charts to the EMR system decreased Figure 2. Although induced costs were incurred, the cumulative NPV was positive as they contributed to additional revenues. Another interesting finding is that the paper-charts management system was cost-centric Figure 3. Year by year, the maintenance costs for the paper-charts were growing. However, the EMR system created new revenues according to this study based on differential costs.
Thus, the adoption of an EMR system is not a matter of choice, but a necessity for management. As described in the Methods section, the data for were based on the SMC's management planning. According to the plan, the estimated number of outpatients per day is 8, The actual measured number during the 1st quarter was 8, The difference was patients per day, or 5.
This will positively affect the benefits, which are based on the number of outpatients per day. However, there is uncertainty as to whether this positive trend will last for the rest of the year. Thus, this study decided to apply the planned number of outpatients in the analysis. This is a considerably conservative CBA in that this study did not included any potential benefits, such as the reduction of adverse drug events, as stated by Kaushal and Bates [ 17 ].
The benefits are much too great to be ignored. There are many difficulties in measuring values. Sometimes, the accuracy of measurement may generate controversy [ 4 , 5 , 7 , 10 ]. It is a limitation that this study does not include such meaningful benefits. This helped to relieve inconveniences to users and resistance to change from the doctors.
It is really arbitrary to set an analysis period in this type of study. Since different results may be found if the analysis period is varied, the results must be interpreted with careful consideration.
Overall, our findings may not always be applicable in all clinical settings since our study was conducted in a single large academic hospital with a rich digital-based infrastructure. All the existing paper-charts were also scanned into the EMR system. To meet user requirements or management strategies requires higher costs. However, it is difficult to say that the EMR system could not be adopted without such convenient services. Therefore, the results may vary with the hospital size, patient volume, and specific IT investment policies.
Although the adoption of an EMR system at a tertiary hospital resulted in overall growth in administrative costs as predicted by Himmelstein et al. The positive NPV, as Wang et al. However, the EMR is a worthwhile investment, seeing that this study did not included any qualitative effects, and the paper-chart system was cost-centric.
This study was a considerably conservative CBA in that any potential benefits were not considered. To support the economic justification of the EMR, more detailed benefits, such as the elimination of labor hours, which are not recorded on the accounting record, should be examined.
Therefore, we recommend that more cases of tangible benefits of EMR should be reported to accelerate its adoption in the future. No potential conflict of interest relevant to this article was reported.
National Center for Biotechnology Information , U. Journal List Healthc Inform Res v. Healthc Inform Res. Published online Sep Find articles by Jong Soo Choi.
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