VALIDATION AND PRELIMINARY EVALUATION OF QOSTMED: A QUALITY AND COST EFFICIENCY BASED ELECTRONIC MEDICAL RECORD MODEL
DOI:
https://doi.org/10.47701/h70n6752Keywords:
electronic medical records, PIECES framework, quality, cost efficiencyAbstract
Background: Electronic medical record (EMR) implementation
requires attention to information quality, system performance,
efficiency, and cost. QOSTMED (Quality and Cost Efficiency Medical
Record) was designed to support quality-oriented and efficient
medical record management and claims processes. This study aimed
to validate and preliminarily evaluate QOSTMED using qualitative
and quantitative approaches.
Methods: Qualitative validation was conducted through a focus
group discussion (FGD) involving experts in EMR, INA-CBGs coding,
and BPJS policy using the PIECES framework: Performance,
Information, Economy, Control, Efficiency, and Service. A limited-scale
trial involved 30 healthcare professionals from two purposively
selected hospitals. A one-group pretest-posttest design compared user
experience between standard EMR and QOSTMED. Paired-samples t-
tests assessed differences across PIECES dimensions.
Results: Expert validation indicated improvements across all PIECES
dimensions. The overall PIECES score increased from 63.5±7.2 with
standard EMR to 74.2±6.5 with QOSMED. Significant differences were
observed in Performance (mean difference=-11.7; p<0.001),
Information (-11.1; p<0.001), Economy (-10.8; p<0.001), Control (-
10.4; p<0.001), Efficiency (-10.1; p<0.001), and Service (-10.9;
p<0.001).
Conclusion: QOSTMED demonstrated significantly better user-rated
performance across all PIECES dimensions than standard EMR.
Further studies with larger samples, comparison groups, and longer
follow-up are warranted.
References
Alobayli, F. et al. (2023) “Electronic Health Record Stress and Burnout Among Clinicians
in Hospital Settings : A Systematic Review,” DIGITAL HEALTH, 9, pp. 1–17.
doi:10.1177/20552076231220241.
Boonstra, A., Versluis, A. and Vos, J.F.J. (2014) “Implementing electronic health records
in hospitals : a systematic literature review,” BMC Health Services Research,
14(370), pp. 1–24. doi:10.1186/1472-6963-14-370.
Burks, K. et al. (2022) “A systematic review of outpatient billing practices,” SAGE Open
Medicine, 10, pp. 1–10. doi:10.1177/20503121221099021.
Davis, J. and Shepheard, J. (2024) “Clinical documentation integrity : Its role in health data
integrity , patient safety and quality outcomes and its impact on clinical coding and
health information management,” Health Information Management Journal, 53(2),
pp. 53–60. doi:10.1177/18333583231218029.
Delone, W.D. and McLean, E.R. (2003) “The DeLone and McLean Model of Information
Systems Success : A Ten-Year Update,” Journal of Management Information
Systems, 19(4), pp. 9–30. doi:10.1080/07421222.2003.11045748.
Ghalavand, H. et al. (2024) “Common data quality elements for health information
systems : a systematic review,” BMC Medical Informatics and Decision Making,
24(243), pp. 1–9. doi:10.1186/s12911-024-02644-7.
Kang, C. and Sarkar, I.N. (2024) “Interventions to Reduce Electronic Health Record-
Related Burnout : A Systematic Review,” Applied Clinical Informatics, 15(1), pp.
10–25. doi:10.1055/a-2203-3787.
Kavandi, H., Al Awar, Z. and Jaana, M. (2024) “Benefits, facilitators, and barriers of
electronic medical records implementation in outpatient settings: A scoping review,”
Healthcare Management Forum, 37(4), pp. 215–225.
doi:10.1177/08404704231224070.
Li, E. et al. (2022) “The Impact of Electronic Health Record Interoperability on Safety and
Quality of Care in High-Income Countries: Systematic Review,” Journal of Medical
Internet Research, 24(9), pp. 1–15. doi:10.2196/38144.
Maqbool, B. and Herold, S. (2024) “Potential effectiveness and efficiency issues in
usability evaluation within digital health : A systematic literature review,” The
Journal of Systems & Software, 111881. doi:10.1016/j.jss.2023.111881.
Mukred, M. et al. (2019) “The Key Factors in Adopting an Electronic Records
Management System ( ERMS ) in the Educational Sector : A UTAUT-Based
Framework,” IEEE Access, 7, pp. 35963–35980.
doi:10.1109/ACCESS.2019.2904617.
Nguyen, L., Bellucci, E. and Nguyen, L.T. (2014) “Electronic health records
implementation : An evaluation of information system impact and contingency
factors,” International Journal of Medical Informatics, 83(11), pp. 779–796.
doi:10.1016/j.ijmedinf.2014.06.011.
Park, S. et al. (2024) “A Systematic Review of Nurses’ Perceptions of Electronic Health
Record Usability Based on the Human Factor Goals of Satisfaction, Performance,
and Safety,” CIN - Computers Informatics Nursing, 42(3), pp. 168–175.
doi:10.1097/CIN.0000000000001084. Pettersen, S., Eide, H. and Berg, A. (2024) “The role of champions in the implementation
of technology in healthcare services : a systematic mixed studies review,” BMC
Health Services Research, 24(456), pp. 1–16. doi:10.1186/s12913-024-10867-7
(2024).
Seligson, M.T. et al. (2021) “Improving clinical documentation of evaluation and
management care and patient acuity improves reimbursement as well as quality
metrics,” Journal of Vascular Surgery, 74(6), pp. 2055–2062.
doi:10.1016/j.jvs.2021.06.027.
Wu, Y. et al. (2024) “Evaluating the Prevalence of Burnout Among Health Care
Professionals Related to Electronic Health Record Use : Systematic Review and
Meta-Analysis,” JMIR Medical Informatics, 12(e54811), pp. 1–19.
doi:10.2196/54811.
Wu, Y. et al. (2025) “Semantics-driven improvements in electronic health records data
quality : a systematic review,” BMC Medical Informatics and Decision Making,
25(298), pp. 1–18. doi:10.1186/s12911-025-03146-w.
