Original ContributionMotivations and barriers to implementing electronic health records and ED information systems in Japan☆,☆☆,★
Introduction
Developed primarily for use in general inpatient and outpatient care, electronic health record systems (EHRs) have improved patient care worldwide [1], [2], [3]. However, extending EHRs to the emergency department (ED) setting has been a challenge due to differences between the requirements of general medical practice and those of an ED. Specifically, EDs must routinely treat several patients simultaneously, and many patients do not schedule their visits [4], [5], [6]. Therefore, EDs require customized emergency department information systems (EDISs) that reflect the unique procedures and treatments performed in emergency care settings [4], [7].
First proposed in 1975 [8], EDISs are now defined broadly as “EHRs designed specifically to manage data and workflow in support of ED patient care and operations [9].” Cumulative evidence indicates that EDISs have improved workflow and patient care in the ED [10]. However, to the best of our knowledge, although there has been only one report on the prevalence of EDIS from the United States [11], the prevalence of EDISs in Japan is not known.
In Japan, EHR adoption started in the 1990s [12], [13], but it is assumed that the prevalence of EDISs remains low [14], [15]. Considering the shortage of medical staff and the increasing number of patients visiting EDs, widespread adoption of user-friendly EDISs is urgently needed to improve workflow and the quality of patient care [13]. To facilitate hospitals’ adoption of such systems (thereby supporting prompt, safe medical treatment in the ED), it is particularly important to determine why hospitals with EHRs hesitate to introduce EDISs. The aim of this multicenter survey was to identify current problems with EHR and the barriers to EDIS adoption in Japan. To this end, we conducted a questionnaire survey on (1) the prevalence of EHR and EDIS adoption, (2) the changes made after EHR introduction, and (3) the barriers to and expectations for EHR-EDIS transitions in Japanese emergency medical facilities with existing EHRs.
Section snippets
Setting: emergency medical facilities in Japan
In Japan, emergency medical facilities are designated as primary, secondary, or tertiary care facilities [16], and paramedics choose the appropriate health care facilities depending on the patient’s condition. Primary care facilities do not have beds, as they are designed for walk-in patients who do not require in-hospital care. Secondary care facilities provide inpatient care to both walk-in patients and those transported by ambulance; these facilities are used to examine and treat patients
Results
Among the 466 hospitals contacted, 215 completed the survey (46.1% response rate) (Table 2). There were no significant differences in hospital size between respondent and nonrespondent hospitals.
Discussion
To the best of our knowledge, this is the first comprehensive national survey of EHRs and EDISs in Japanese hospitals to explore barriers to and expectations for EDISs implementation in hospitals with existing EHRs. First, the current survey identified that only 9 hospitals (4.2%) had comprehensive EHR, and only 4 hospitals (1.9%) had EDIS. Second, ED directors reported that the introduction of EHR did not change the time required to create medical records and did not reduce overall clinic
Limitations
The present study has several limitations. First, we achieved only a 46.1% response rate, and the hospitals that did not respond to our survey were somewhat different from those that did respond. We found no significant hospital size difference between the hospitals that did and did not respond to our survey. However, because this survey was completed anonymously, it was difficult for us to follow the nonrespondents. According to the supplemental small-scale phone interviews after the survey,
Conclusion
We found that very few hospitals have comprehensive EHR systems or EDIS in Japan. As EHR-EDIS transitions become faster, providers and emergency physicians together should focus on developments that decrease cost, shorten the time to create medical records, and incorporate clinical guidelines.
Acknowledgments
We thank the physicians who participated in the survey and Ms Takako Sakamaki, who assisted with data collection. Finally, we thank the Japanese Association of Healthcare Information Systems for providing data.
References (31)
- et al.
Quality and safety implications of emergency department information systems
Ann Emerg Med
(2013) Health data use and protection policy; based on differences by cultural and social environment
Int J Med Inform
(2000)- et al.
Current policies on informed consent in Japan constitute a formidable barrier to emergency research
Resuscitation
(2014) - et al.
Emergency medicine in Japan
Ann Emerg Med
(2001) - et al.
The trends in EMR and CPOE adoption in Japan under the national strategy
Int J Med Inform
(2013) - et al.
The impact of electronic health records on time efficiency of physicians and nurses: a systematic review
J Am Med Inform Assoc
(2005) - et al.
Medical error prevention in ED triage for ACS: use of cardiac care decision support and quality improvement feedback
Cardiol Clin
(2005) - et al.
Systematic review: impact of health information technology on quality, efficiency, and costs of medical care
Ann Intern Med
(2006) - et al.
Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review
J Am Med Assoc
(2005) - et al.
Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success
Br Med J
(2005)
Health information technology
Ann Emerg Med
Keynote address: medical informatics and emergency medicine
Acad Emerg Med
Emergency medicine information technology consensus conference: executive summary
Acad Emerg Med
CPHA developing emergency department information system
Bull Am Coll Physicians
Emergency department information systems (EDIS) functional profile
Cited by (24)
Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States
2019, International Journal of Medical InformaticsCitation Excerpt :Respective frameworks include single scale variables [46,47], composite models [23,48] and conditional stage models [49]. The definition given by Jha et al. [50] evolved to be one of the most widely used definitions in EHR diffusion and adoption research worldwide [22,44,48,51]. It proposes a set of 24 core EHR functionalities, and it distinguishes between basic and comprehensive EHRs [43,50].
Impact of electronic medical records (EMRs) on hospital productivity in Japan
2018, International Journal of Medical InformaticsCitation Excerpt :Since then, the number of medical institutions implementing an EMR system has increased steadily. In Japan, EMR systems implemented in hospital settings typically interface with systems related to clinical documentation, computerized provider-order entry, access to test and imaging results, and billing [13]. Alongside the use of such basic systems [3], hospitals varied in their use of clinical decision support systems [13].
Interface design dividing physical findings into medical and trauma findings facilitates clinical document entry in the emergency department: A prospective observational study
2018, International Journal of Medical InformaticsCitation Excerpt :Ambulatory patients are usually examined at primary hospitals. If an ambulance is called, the patients are generally transferred to a secondary or tertiary hospital depending on the severity of their condition [13–15]. This study was conducted at a single hospital in charge of primary/secondary emergencies.
Low-Cost Feedback Program for Reducing the Door-to-Computed Tomography Time
2022, Cerebrovascular Diseases ExtraUsability of Emergency Department Information System Based on Users’ Viewpoint; a Cross-Sectional Study
2022, Archives of Academic Emergency Medicine
- ☆
Grant: This work was funded by a grant-in-aid for Young Scientists (C) (127100000424) to HS, MG, NY, and SN and a Health Labour Sciences Research Grant to HS, NY, and SN.
- ☆☆
Author contribution: RI conceived the study. RI, HS, YK, and SN designed the analysis plan. RI and HS performed the statistical analyses. RI wrote the first draft of the study. KN and YA contributed to draft of the study. RI, KN, MG, TM, YK, NY, and SN obtained the data. YA, KS, and NY critically reviewed the manuscript. All authors contributed to the design, interpretation of results, and critical revision of the article for intellectually important content.
- ★
Conflicts of interest statement: The authors declare that they do not have any conflicts of interest.