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Impact of Doctors’ Resistance on Success of Drug Utilization Review System
최종수,윤성현,김동수,박승우 대한의료정보학회 2014 Healthcare Informatics Research Vol.20 No.2
Objectives: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors’ resistance. This study aimed to analyze the impacts of doctors’ resistance on the success of the DUR system. Methods: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors’ resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable ‘use’ because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. Results: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors’ resistance. Doctors’ resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. Conclusions: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors’ resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
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Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital
최종수,이우백,이풍렬 대한의료정보학회 2013 Healthcare Informatics Research Vol.19 No.3
Objectives: Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods: Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists’ contribution. The measured amounts were discounted by SMC’s expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results: During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions: Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
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스마트폰 기반 의료 애플리케이션 사용 현황 및 이슈 분석
최종수,김동수 대한산업공학회 2011 대한산업공학회 추계학술대회논문집 Vol.2011 No.11
병원들이 앞 다투어 도입, 적용하는 스마트폰 솔루션에 대한 개발업체들의 홍보자료는 많으나 적용 사례와 사용량을 비교 분석한 연구는 거의 없다. 특히 전화 통화와 같은 음성 서비스와 스마트폰 애플리케이션 서비스 같은 데이터 서비스의 사용량을 비교 분석한 시도는 없었다. 이에 본 연구에서는 삼성서울병원 에서 유무선 통합 서비스를 도입한 후 음성 서비스 사용량을 분석한 자료와 최근 기존의 모바일 솔루션을 안드로이드 기반으로 업그레이드한 이후의 사용량을 비교 분석하였다. 삼성서울병원에서 사용하고 있는 모바일 애플리케이션의 주요 메뉴는 입원환자, 외래환자, 응급환자, 수술환자, 협진 의뢰 내용, 입원예정 환자 정보로 구성되어 있으며, 이는 삼성서울병원 종합의료정보시스템의 축소판이라 할 수 있다. 최근 아이폰 또는 안드로이드 기반의 스마트폰이 출시되기 전까지는 스마트폰의 열풍이 없었던 것처럼 의사들의 접속 현황이 뚜렷이 낮았다. 그러나 2011년에 측정된 안드로이드 기반의 애플리케이션 서비스는 2006년 대비 11.5배 이상 증가하였다는 것이다. 유무선 통합 서비스를 이용한 음성 서비스와 애플리케이션 사용현황의 시간대별 분석한 결과, 유사한 형태의 사용현황을 보이고 있다. 특히 아침 회진 시간대인 6시부터 8시 사이 데이터 서비스 사용량이 먼저 증가하고 약 1시간 후부터 음성 통화 서비스가 증가하는 것은 회전 전에 데이터 서비스를 먼저 활용한다고 볼 수 있다. 오후 5시 이후 저녁 시간대는 음성 통화 서비스는 급격히 감소하지만 애플리케이션을 통한 데이터 서비스가 근무시간대와 유사한 수준을 유지하고 있다. 본 연구는 실제 임상 현장에 적용된 스마트 폰 기반의 유무선 통합 서비스를 이용한 음성 서비스 사용 현황과 애플리케이션 사용현황에 대한 분석힌 첫 사례로서 그 의미가 크다.
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The Uses of the Smartphone for Doctors: An Empirical Study from Samsung Medical Center
최종수,이병기,박종환,최계숙,정재곤,박승우,이풍렬 대한의료정보학회 2011 Healthcare Informatics Research Vol.17 No.2
Objectives: In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information,then review the consequences of its use and discuss its future direction. Methods: Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. Results:We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Conclusions: Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements.
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