Computerized Physician Order Entry and Electronic Medical Record Systems in Korean Teaching and General Hospitals: Results of a 2004 Survey

Design: A combined mail and telephone survey of 283 hospitals. Measurements: The surveys assessed the availability of CPOE and EMRs in the hospitals, as well as inducement, participation, and saturation regarding CPOE use by physicians. Results: A total of 122 (43.1%) hospitals responded to the survey. The complete form of CPOE was available in 98 (80.3%) hospitals. The use of CPOE was mandatory in 92 (86.0%) of the 107 hospitals that responded to the questions regarding the requirement of CPOE use. In 85 (79.4%) of the hospitals in which CPOE was in use, more than 90% of physicians used the system. In addition, physicians entered more than 90% of their total orders through CPOE in 87 (81.3%) hospitals. In contrast, a complete EMR system was available in only 11 (9.0%) of the hospitals. Conclusion: Of the teaching and general hospitals in the Republic of Korea that responded to the survey, the majority (80.3%) have CPOE systems, and a complete EMR system is available in only 9%. j J Am Med Inform Assoc. 2005;12:642–647. DOI 10.1197/jamia.M1768. Many hospitals around the world have implemented computerized physician order entry (CPOE) systems. Numerous publications cite the benefits of using CPOE. However, many drawbacks and difficulties associated with CPOE use have been described as well. The use of CPOE systems in Korean hospitals and clinics has been widely accepted since their first introduction to the Republic of Korea in 1982. A brief report about Korean hospital information systems was published in Korea in 2003. That study differed in design from the present survey, used different terminology that did not include CPOE, and did not assess the availability of complete electronic medical records (EMRs). To our knowledge, this is the first report presented to the outside world concerning Korean data on CPOE and EMR use. Ash et al. discovered that 16.5% of American hospitals had CPOE available to some degree (9.6% completely, 6.5% partially) in 2002. According to Health Care News, the rates of EMR use by general practitioners in the Western world in 2002 were 90% in Sweden, 88% in the Netherlands, 62% in Denmark, 58% in the United Kingdom, 56% in Finland, 55% in Austria, and 17% in the United States. A similar study conducted in Korea in 2003 to survey the computerization status of private clinics revealed that 259 (58.2%) of 445 clinics used an EMR system for their outpatients. Due to differences in practice patterns and national health care systems, difficulties arise in comparing these survey results among nations. Different populations, survey methods, types of questionnaires, and varying definitions of CPOE and EMR influence survey results. In order to allow direct comparisons, we adopted a survey form used in previous studies in the United States. Although a detailed and well-designed survey may be advantageous in collecting more information, a survey form that is too complicated will decrease the response rate, resulting in a nonrepresentative result. Ash et al. have developed a simple survey form, a postcard with a brief set of questions, to assess CPOE status. We decided to use the same postcard and brief questionnaire in our survey, with the permission of one of the authors (Joan Ash). We added one additional question about EMR availability to the original survey. Affiliations of the authors: Departments of Biomedical and Healthcare Informatics (RWP, SCH) and Pulmonary and Critical Care Medicine (SSS, YIC), Ajou University School of Medicine, Suwon, Republic of Korea; Department of Medical Informatics, College of Medicine, Soon Chun Hyang University, Asan, Republic of Korea (JOA). This study was supported by a grant of the Korean Health 21 R&D; Project, Ministry of Health & Welfare, Republic of Korea (no. A050571). Correspondence and reprints: Sung Chul Hwang, MD, Department of Biomedical and Healthcare Informatics, Ajou University School of Medicine, San 5, Youngtong-Gu, Suwon 442-721, Republic of Korea; e-mail: . Received for review: 12/12/04; accepted for publication: 06/08/05. 642 PARK ET AL., CPOE and EMR Status in Korean Hospitals