title: Motivations and barriers to implementing electronic health records and ED information systems in Japan.
abstract: BACKGROUND
  Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan.
  
  
  METHODS
  A survey regarding EHR (basic or comprehensive) and EDIS implementation was mailed to 466 hospitals. We examined the efficiency after EHR implementation and perceived barriers and expectations regarding the use of EDIS with existing EHRs. The survey was completed anonymously.
  
  
  RESULTS
  Totally, 215 hospitals completed the survey (response rate, 46.1%), of which, 76.3% had basic EHRs, 4.2% had comprehensive EHRs, and 1.9% had EDISs. After introducing EHRs and EDISs, a reduction in the time required to access previous patient information and share patient information was noted, but no change was observed in the time required to produce medical records and the overall time for each medical care. For hospitals with EHRs, the most commonly cited barriers to EDIS implementation were inadequate funding for adoption and maintenance and potential adverse effects on workflow. The most desired function in the EHR-EDIS transition was establishing appropriate clinical guidelines for residents within their system.
  
  
  CONCLUSIONS
  To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Inokuchi
authors.affiliation: Department of Health Policy and Technology Assessment, National Institute of Public Health 2-3-6 Minami, Wako, Saitama 351-0197, Japan. Electronic address: hsato-tky@umin.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shinohara
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Gunshin
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kitsuta
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakajima
mesh_terms: D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D006751:Hospital Information Systems / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors