Abstract
A key purpose of electronic medical records (EMR) introduced in medical institutions is to improve work efficiency. The average length of stay (LOS) is just an important indicator to evaluate work efficiency of medical care in hospitals. Recently, there have been reports about effects of EMR application on LOS in medical institutions, but they have been mostly based on the overall analysis of a region or a hospital and not of specific clinical departments and diseases or based on longer time periods. Therefore, in this study, we selected four clinical departments and four diseases with the largest number of inpatients from January 2004 to December 2012 in a Chinese 3A general hospital and used an interrupted time-series method by the departments and diseases to analyze the relationship of EMR application and LOS. Through our analyses, we concluded that, under unadjusted condition, LOS were all reduced (P < 0.001) after EMR application in four departments and for four diseases. After adjustment by gender, age or admission condition, LOS still all decreased after EMR application (P < 0.05) regardless of departments or diseases. The trend changes in LOS reversed from increasing to decreasing in the orthopedics department (coefficient: 0.016 to −0.079), the cardiovascular surgery department (coefficient: 0.007 to −0.126) and all departments overall (coefficient: 0.004 to −0.070), as well as for the intervertebral disc disorders (coefficient: 0.026 to −0.068). Furthermore, the decreasing trend gained a larger slope in the cardiology department (coefficient: −0.017 to −0.023), the neurology department (coefficient: −0.012 to −0.043) and for the coronary heart disease (coefficient: −0.010 to −0.018), the ventricular septal defect (coefficient: −0.024 to −0.059), and the cerebral infarction (coefficient: −0.031 to −0.040). Together, these findings indicate that EMR application coincided with a decrease in LOS and may have a contribution to the decrease.
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Holroyd-Leduc, J., Lorenzetti, D., Straus, S., Sykes, L., and Quan, H., The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence. J Am Med Inform Assoc 18(6):732–737, 2011.
Kiah, M. L., Nabi, M. S., Zaidan, B. B., and Zaidan, A. A., An enhanced security solution for electronic medical records based on AES hybrid technique with SOAP/XML and SHA-1. Journal of medical systems 37(5):9971, 2013. doi:10.1007/s10916-013-9971-2.
Geisler, B. P., Schuur, J. D., and Pallin, D. J., Estimates of electronic medical records in U.S. emergency departments. PLoS One 5(2):e9274, 2010. doi:10.1371/journal.pone.0009274.
Noblin, A., Cortelyou-Ward, K., Cantiello, J., Breyer, T., Oliveira, L., Dangiolo, M., Cannarozzi, M., Yeung, T., and Berman, S., EHR implementation in a new clinic: a case study of clinician perceptions. Journal of medical systems 37(4):9955, 2013. doi:10.1007/s10916-013-9955-2.
Li, J. S., Zhang, X. G., Wang, H. Q., Wang, Y., Wang, J. M., and Shao, Q. D., The meaningful use of emr in chinese hospitals: a case study on curbing antibiotic abuse. Journal of medical systems 37(2):9937, 2013. doi:10.1007/s10916-013-9937-4.
Rosen, P., Spalding, S. J., Hannon, M. J., Boudreau, R. M., and Kwoh, C. K., Parent satisfaction with the electronic medical record in an academic pediatric rheumatology practice. J Med Internet Res 13(2):e40, 2011. doi:10.2196/jmir.1525.
Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R., Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood) 24(5):1103–1117, 2005. doi:10.1377/hlthaff.24.5.1103.
Kuperman, G. J., and Gibson, R. F., Computer physician order entry: benefits, costs, and issues. Annals of internal medicine 139(1):31–39, 2003.
Choi, C. K., Saberito, D., Tyagaraj, C., and Tyagaraj, K., Organizational performance and regulatory compliance as measured by clinical pertinence indicators before and after implementation of anesthesia information management system (AIMS). Journal of medical systems 38(1):5, 2014. doi:10.1007/s10916-013-0005-x.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., and Shekelle, P. G., Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of internal medicine 144(10):742–752, 2006.
Chao, W. C., Hu, H., Ung, C. O., and Cai, Y., Benefits and challenges of electronic health record system on stakeholders: a qualitative study of outpatient physicians. Journal of medical systems 37(4):9960, 2013. doi:10.1007/s10916-013-9960-5.
Wright, A., McGlinchey, E. A., Poon, E. G., Jenter, C. A., Bates, D. W., and Simon, S. R., Ability to generate patient registries among practices with and without electronic health record. J Med Internet Res 11(3):e31, 2009.
Aljarullah, A., and El-Masri, S., A novel system architecture for the national integration of electronic health records: a semi-centralized approach. Journal of medical systems 37(4):9953, 2013. doi:10.1007/s10916-013-9953-4.
Garg, A. X., Adhikari, N. K., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., and Haynes, R. B., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA : the journal of the American Medical Association 293(10):1223–1238, 2005. doi:10.1001/jama.293.10.1223.
Kaboli, P. J., Barnett, M. J., and Rosenthal, G. E., Associations with reduced length of stay and costs on an academic hospitalist service. Am J Manag Care 10(8):561–568, 2004.
Srivastava, R., Landrigan, C. P., Ross-Degnan, D., Soumerai, S. B., Homer, C. J., Goldmann, D. A., and Muret-Wagstaff, S., Impact of a hospitalist system on length of stay and cost for children with common conditions. Pediatrics 120(2):267–274, 2007.
Xue, Y., Liang, H., Wu, X., Gong, H., Li, B., and Zhang, Y., Effects of electronic medical record in a Chinese hospital: a time series study. International journal of medical informatics 81(10):683–689, 2012. doi:10.1016/j.ijmedinf.2012.05.017.
Lee, J., Kuo, Y. F., and Goodwin, J. S., The effect of electronic medical record adoption on outcomes in US hospitals. BMC Health Serv Res 13:39, 2013. doi:10.1186/1472-6963-13-39.
Schenarts, P. J., Goettler, C. E., White, M. A., and Waibel, B. H., An objective study of the impact of the electronic medical record on outcomes in trauma patients. Am Surg 78(11):1249–1254, 2012.
Furukawa, M. F., Raghu, T. S., and Shao, B. B., Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from California hospitals, 1998–2007. Health services research 45(4):941–962, 2010. doi:10.1111/j.1475-6773.2010.01110.x.
Ranking list in China's hospitals. http://www.cn-healthcare.com/hospitalrank/column1.html.
W H, A W (2008) What workforce is needed to implement the health information technology agenda? Analysis from the HIMSS analytics database. AMIA Annual Symposium proceedings/AMIA Symposium AMIA Symposium Nov 6:303–307
Electronic Medical Record Adoption Model (EMRAM). http://www.himssanalytics.org/emram/index.aspx.
Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., and Roland, M., Effects of pay for performance on the quality of primary care in England. The New England journal of medicine 361(4):368–378, 2009. doi:10.1056/NEJMsa0807651.
Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, Soumerai SB (2011) Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ 342 (jan25 3):d108. doi:10.1136/bmj.d108
Morgan, O. W., Griffiths, C., and Majeed, A., Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS medicine 4(4):e105, 2007. doi:10.1371/journal.pmed.0040105.
Longhurst, C. A., Parast, L., Sandborg, C. I., Widen, E., Sullivan, J., Hahn, J. S., Dawes, C. G., and Sharek, P. J., Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics 126(1):14–21, 2010. doi:10.1542/peds.2009-3271.
Wagner, A. K., Soumerai, S. B., Zhang, F., and Ross-Degnan, D., Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 27(4):299–309, 2002.
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This work was supported by the National Natural Science Foundation of China (Grant No. 81102202).
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Peng Yang and Yi Cao contributed equally to this work.
This article is part of the Topical Collection on Systems-Level Quality Improvement
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Yang, P., Cao, Y., Liu, D. et al. The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study. J Med Syst 38, 53 (2014). https://doi.org/10.1007/s10916-014-0053-x
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DOI: https://doi.org/10.1007/s10916-014-0053-x