title: The meaningful use of EMR in Chinese hospitals: a case study on curbing antibiotic abuse.
abstract: Comprehensive electronic medical records (EMR) have proven to be an effective tool for improving the safety and quality of healthcare. In particular, EMR has resulted in a significant reduction in antibiotic consumption and an improvement in rational antibiotic use. This study focused on evaluating the effectiveness of using a comprehensive EMR system to curb antibiotic abuse. A retrospective "before/after" investigation was conducted in an 850-bed nonprofit hospital. A comprehensive EMR was implemented to improve the management of medical practices during treatment and to track antibiotic prescriptions. Patient records on antibiotic use were identified by searching the hospital database from April 1 to October 30, 2011 (post-implementation) and compared with those of patients from April 1 to October 30, 2010 (pre-implementation). Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days and factors that influenced antibiotic consumption. Antibiotic consumption during the seven months with EMR management decreased from 727 DDDs to 480 DDDs per 1,000 patient-days (p < 0.001). The decreases in cefminox, cefoperazone combinations, cefixime, and gentamicin were notably significant. The type of medical insurance, patient age, and ordering department (importance coefficients of 0.1935, 0.1818 and 0.1756, respectively) were the most significant factors that influenced antibiotic consumption. An improvement in the rational antibiotic use was also observed in the length of antibiotic therapy, selection of appropriate antibiotic level, route of administration, and so on. Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use.
authors.affiliation: Healthcare Informatics Engineering Research Center, Zhejiang University, Hangzhou, 310027, China, ljs@zju.edu.cn.
authors.forename: Jing-Song
authors.initials: JS
authors.lastname: Li
authors.forename: Xiao-Guang
authors.initials: XG
authors.lastname: Zhang
authors.forename: Hua-Qiong
authors.initials: HQ
authors.lastname: Wang
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Jing-Ming
authors.initials: JM
authors.lastname: Wang
authors.forename: Qing-Dong
authors.initials: QD
authors.lastname: Shao
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D062527:Meaningful Use; D008485:Medical Audit; D019982:Organizational Case Studies; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents