dc.description.abstract |
Electronic medical record systems (EMRS) are increasingly being adopted
worldwide. While their benefits are well known, the costs of implementing and maintaining
such EMRs in resource constrained settings are not well documented. Establishing such costs
is crucial to enable policy and fiscal planners make sound decisions in allocation of scarce
resources across multiple areas of need.
Objective: To conduct a comprehensive cost analysis for developing, implementing and
maintaining an EMRS specifically looking at the direct costs for the development and
implementation, the cost implications with use of an EMR as compared to paper based
medical record system as well as a trend analysis of the cost of an EMR in resource limited
settings.
Methods: This study was conducted at the Infectious Diseases Institute (IDI), a public
HIV/AIDS care clinic situated in Kampala, Uganda an implementer of a custom-made
EMRS. A comprehensive direct cost analysis was conducted using an organizational
perspective. Elements for cost at pre-implementation, implementation and maintenance
phases were identified based on industry-accepted cost metrics. Cost units were determined
based on data from primary sources. A cost inventory was developed and used to extract data
from the market survey findings, original receipts and invoices for associated products. Costs
with a lifetime of greater than one year were annuitized and a standard-recommended Uganda
government depreciation rate of 40% was applied. The costs were converted to their
equivalent dollar value using the government of Uganda dollar rates and the total costs are
reported. Sensitivity analysis was conducted to account for uncertainty.
Results: The total calculated cost of the IDI EMRS, since its inception in January 2009 until
December 2016, was USD 1,066,965 while an opensource instance would cost just over USD
800,000. The annuitized total cost was USD 1,084,498. Maintaining a paper based medical
record system over the same time would have cost almost half the cost of the EMR (USD
544,159). Salaries and wages contributed 70% (USD 757,332) and 81% (USD 438,842) of
costs in the EMRS and paper-based system, respectively. Other cost drivers included
software and licensing (20%, USD 258,341) in the EMRS and stationery (17%, USD 90,854)
in the paper system. The sensitivity analysis model with open source architecture resulted in
a 20% reduction in the total cost of the EMRS. Inclusion of public service rates to the model
led to a further 25% reduction in the total cost of the EMRS. The costs expended showed a
gradual decrease with time.
Conclusion: EMRS have higher costs as compared to paper-based medical record systems.
However, expenditure on the system reduces with time. Salaries and wages are the largest
contributors to the cost burden. Opensource systems have a potential to lower costs.
Recommendations: There is need to utilize open opensource systems to minimize costs as
well as devise means of lowering personnel costs. |
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