اجرای پرونده الکترونیکی سلامت و بهره وری عوامل کل در بیمارستان

The adoption and implementation of electronic health record (EHR) systems have been widely promoted as a means for improving health care delivery and controlling costs in U.S. hospitals. To date, the results of efforts to adopt such systems have been mixed and often unsuccessful. This paper uses frontier analysis to measure hospitals' Total Factor Productivity (TFP) during 2006–2008 and compare it to nine different stages of EHR implementation. Overall, we find that hospitals implementing EHR systems have lower TFP gains relative to those facilities that have as yet to adopt. In particular, hospitals that attempt to fully implement an EHR in one year, the ‘Big Bang’ strategy, have relatively low TFP levels. Therefore, the anticipated savings from increased EHR use may not be realized in the near-term for EHR system adopters. Moreover, an evidence-based approach to developing the ‘Meaningful Use’ incentive and reward program for EHR implementation is warranted.

The U.S. healthcare system is far more costly to operate on a per capita basis than that of any other industrialized nation, many of which achieve comparable or superior clinical outcomes. One of the primary explanations offered for this excessive cost difference is the poor care coordination within U.S. hospitals. For example, both the duplication of diagnostic tests [32] and ordering unnecessary tests [37] could be avoided with better health information management. Further, as much as 20%, and perhaps more, of hospitals' lab orders are either unnecessary duplications or inappropriate requests that could be avoided [22] and [32]. In 2008, Peter Orszag, the Director of the Congressional Budget Office, estimated that five percent of the nation's GDP, about $700 billion dollars per year, goes towards tests and procedures that do not improve health outcomes [30]. When one considers that the total cost of health care in the U.S. is estimated at 17%, this assessment implies that 30% of all healthcare expenses do not improve health outcomes. The difference in these numbers suggests an assessment on the costs associated with potential savings related to the ‘Meaningful Use’ of health information, such as avoiding medical errors, and the magnitude of the avoidable costs becomes much larger.

Computerization of clinical information is an essential component of a broader system of hospital changes. To gain productivity advantages from computers in healthcare settings, rather than simply computerizing their traditional practices, managers have to re-engineer the hospital to match their workflows with the capabilities of new EHR systems. Therefore, it is necessary to implement work process changes throughout the hospital, which represents a major technological change. Further, it is reasonable to assume that changes in EHR would impact hospital productivity negatively in the short-run. There is more to implementing an EHR system than just the installation of new computers. The transition to an EHR environment from a paper system must occur concomitantly with a rethinking of job processes, employees' new roles and responsibilities (i.e., scope of practice) and the needed organizational hierarchy changes [10]. Among other things, the move to a fully functional EHR implies upgrading the skills of the workforce, which would impact EFFCH favorably. Further, for increasing productivity and fostering innovation, a multi-disciplinary educated workforce is critical to being able to use evidence-based guidelines. Nonetheless many organizations retain their old structures because the required EHR changes are time consuming to learn, risky, and initially costly. In large part this problem emerges because such changes are perceived as impinging on the professional domains of the many clinically trained stakeholders–physicians in particular [6]. Therefore, rather than changing their behavior or increasing the skills of current staffers, it is a more common strategy to add a costly specialist (i.e., outsourcing) to handle specific types of EHR issues in professional domains. The increase use of scribes is one indication that this phenomenon may be occurring [1]. For the sample of U.S. hospitals studied, TFP levels increased from 2006 to 2008, but only to a small degree. Further, the TFP gains witnessed are largely the result of increases in EFFCH rather than changes in the underlying technological processes (TC) used by facilities.