Clinical Decision Support Functions and Digitalization of Clinical Documents of Electronic Medical Record Systems / 대한의료정보학회지

OBJECTIVES: The objective of this study was to investigate the clinical decision support (CDS) functions and digitalization of clinical documents of Electronic Medical Record (EMR) systems in Korea. This exploratory study was conducted focusing on current status of EMR systems. METHODS: This study used a nationwide survey on EMR systems conducted from July 25, 2018 to September 30, 2018 in Korea. The unit of analysis was hospitals. Respondents of the survey were mainly medical recorders or staff members in departments of health insurance claims or information technology. This study analyzed data acquired from 132 hospitals that participated in the survey. RESULTS: This study found that approximately 80% of clinical documents were digitalized in both general and small hospitals. The percentages of general and small hospitals with 100% paperless medical charts were 33.7% and 38.2%, respectively. The EMR systems of general hospitals are more likely to have CDS functions of warnings regarding drug dosage, reminders of clinical schedules, and clinical guidelines compared to those of small hospitals; this difference was statistically significant. For the lists of digitalized clinical documents, almost 93% of EMR systems in general hospitals have the inpatient progress note, operation records, and discharge summary notes digitalized. CONCLUSIONS: EMRs are becoming increasingly important. This study found that the functions and digital documentation of EMR systems still have a large gap, which should be improved and made more sophisticated. We hope that the results of this study will contribute to the development of more sophisticated EMR systems.

Association between Electronic Medical Record System Adoption and Healthcare Information Technology Infrastructure / 대한의료정보학회지

OBJECTIVES: The objective of this study was to investigate the relationship between the level of Electronic Medical Record (EMR) system adoption and healthcare information technology (IT) infrastructure. METHODS: Both survey and various healthcare administrative datasets in Korea were used. The survey was conducted during the period from June 13 to September 25, 2017. The chief information officers of hospitals were respondents. Among them, 257 general hospitals and 273 small hospitals were analyzed. A logistic regression analysis was conducted using the SAS program. RESULTS: The odds of having full EMR systems in general hospitals statistically significantly increased as the number of IT department staff members increased (odds ratio [OR] = 1.058, confidence interval [CI], 1.003–1.115; p = 0.038). The odds of having full EMR systems was significantly higher for small hospitals that had an IT department than those of small hospitals with no IT department (OR = 1.325; CI, 1.150–1.525; p < 0.001). Full EMR system adoption had a positive relationship with IT infrastructure in both general hospitals and small hospitals, which was statistically significant in small hospitals. The odds of having full EMR systems for small hospitals increased as IT infrastructure increased after controlling the covariates (OR = 1.527; CI, 1.317–4.135; p = 0.004). CONCLUSIONS: This study verified that full EMR adoption was closely associated with IT infrastructure, such as organizational structure, human resources, and various IT subsystems. This finding suggests that political support related to these areas is indeed necessary for the fast dispersion of EMR systems into the healthcare industry.

CDA Compression via Automatic Type Inference / 대한의료정보학회지

OBJECTIVE: CDA is a standard for the exchange and sharing of clinical documents among all entities in the healthcare domain. As it proliferates, the number of CDA documents will increase exponentially and it will require huge storage spaces to store them. The main goal of this study is to devise an efficient compression method optimized for CDA documents so that the storage requirement can be lowered. METHODS: The method proposed in this paper is based on a compression method called Xmill which has been designed specifically for XML documents at large, which requires human intervention for the effective compression, especially, of CDA. Our proposed method, CDACOM, automatically extracts type information from CDA documents to infer the data type, assigns data values of the same type to the same data container, and applies an optimized encoder to the container so that a better compression rate can be achieved. RESULTS: Experiments with various types of CDA documents were performed to evaluate the effectiveness of CDACOM over Xmill. The results show that CDACOM indeed outperforms Xmill and can decrease the output file size by about 24.1% on average, compared to Xmill. If documents are combined and compressed together, the gap gets even bigger to about 50%. CONCLUSION: The proposed compression method, CDACOM, is very effective and promising. It will help lowering the cost for systems to transmit and store CDA documents and, hence, expediting the adoption of the standard in the healthcare domain.