JMIR Publications

ABSTRACT

Background:

The rapid aging of the Taiwanese population has led to high medical needs for the elderly and increasing medical costs in recent years. The integration of patient information through electronic health records (EHRs) to reduce unnecessary medications and tests and enhance the quality of care has currently become an important issue.

Objective:

Although electronic data interchanges among hospitals and clinics have been implemented for many years in Taiwan, the interoperability of EHRs has still not been assessed. Hence, in this study, we analyzed the efficiency of data exchanges and provide suggestions for future improvements.

Methods:

We obtained 30 months of uploaded and downloaded data of EHRs among hospitals and clinics from the EMR Exchange Center (EEC) of the Ministry of Health and Welfare (MOHW) from January 2015 to June 2017. The objects of this study consisted of 21 medical centers, 84 district hospitals, 290 area hospitals and 5520 clinics. The four exchange EHR forms examined were blood tests, medical images, discharge summaries, and outpatient medical records. We used MYSQL software to save our data and used phpMyAdmin which is a PHP program to manage the database and then analyzed the data using SPSS 19.0 statistical software.

Results:

The quarterly mean uploaded volume of EHRs among hospitals was 52,790,721 (standard deviation (SD): 580,643) records. The quarterly mean downloaded volume of EHRs among hospitals and clinics was 650,323 (SD: 215,099) records. The ratio of uploaded to downloaded EHRs was about 81:1. The total volume of EHRs was mainly downloaded by medical centers and clinics which accounted for 53.8% (mean: 318,717.80) and 45.4% (mean: 269,082.10), respectively, and the statistical test was significant among different hospital accreditation levels (F=7.63, p<0.001). A comparison of EHR download volumes among the six National Health Insurance (NHI) branches showed that the central NHI branch downloaded 11,366,431 records (21.53%) which was the highest, and the eastern branch downloaded 1,615,391 records (3.06%) which was the lowest, and the statistical test among the six NHI branches was significant (F=8.82, p<0.001). The download volumes of laboratory tests and outpatient medical records were 26,980,425 (50.3%) and 21,747,588 records (40.9%), respectively, and were much higher than medical images and discharge summaries, and the statistical test was also significant (F=17.72, p<0.001). Finally, the download times showed that the average for x-rays was 32.05 seconds which was the longest, and 9.92 seconds for electrocardiograms which was the shortest, but there was no statistically significant difference among download times for various medical images.

Conclusions:

After years of operation, the EEC has achieved the initial goal of EHR interoperability, and data exchanges are running quite stably in Taiwan. However, the meaningful use of EHRs among hospitals and clinics still needs further encouragement and promotion. We suggest that the government’s leading role and collective collaboration with healthcare organizations are important keys to providing effective health information exchanges. Clinical Trial: MOHW105-IM-I-114-000017 (Department of Health and Welfare)