Abstract
BackgroundNation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size.MethodsEMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated.ResultsWe found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals.ConclusionMeasuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.
Highlights
Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care
The key functions contained in EHRs are computerized physician order entries (CPOE) [4,5,6,7], closed-loop medication administration records (CLMA) [8,9,10,11,12], clinical decision support systems (CDSS) [13,14,15], picture archiving and communication systems (PACS) [16], and electronic medication administration records [9, 17, 18]
The results of this study showed that while the United States of America (USA) and Japan have similar status in 2008 and 2011, the USA became better than Japan in adopting EHR for small, medium, and large hospitals in 2014
Summary
Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. Electronic health records (EHRs), as defined by the Turkish Ministry of Health (MoH), is any information recorded, stored, transmitted, accessed, correlated, and processed by using electronic systems related to past, present and future physical and mental health condition or diseases of individuals [1]. This information repository, when used in a meaningful manner, keeps all of the records that are useful, effective, ethical, and accessible within regulated boundaries [2, 3]. Despite varying content and structure due to the local health insurance system, electronic medical billing (EMB) systems are another crucial HIS component integrated with EHRs and PAS [20]
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