Examine the impact of the implementation of an electronic medical record system on operating theatre efficiency at a teaching hospital in Australia


  • Tzu-Yi Arron Chuang Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia
  • Nathan Yii Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia
  • Masimba Nyandowe Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia
  • Ramesh Iyer Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia




Australia, Implementation of an electronic medical record, Theatre efficiency


Background: The utilization of electronic medical record (EMR) system has become the mainstay of healthcare system in developed countries. In the last five years, Queensland Health has gradually implemented EMR system for hospitals in Queensland, Australia. As far as we are aware, no study has been conducted to assess the impact of the EMR implementation on operating theatre efficiency in Australia.

Methods: A retrospective review of general surgery operating room on time start data was performed for a period of 2 months prior and 2 months following implementation of the EHR. A delay was defined as the time between the scheduled start time and “first in” times. Outcomes measured included the total number of sessions run, number of sessions starting late, average delay time and case cancellations.

Results: During the EMR training period, the number of sessions which had delayed increased from 13.2% to 31.0%. Following implementation of the EMR, delays were present for 88% of sessions for the first month with an average delay time of 21.8 minutes. The second month showed an overall improvement with 69% of sessions delayed and a reduced average delay time of 10.4mins.

Conclusions: The implementation of a new electronic medical record system is associated with delays in theatre start times especially during the training period and first month of use. Evidence of recovery of service efficiency however is seen by the second month post-implementation with further expected improvement if trends continue.


Frazee R, Cames A, Munoz Maldonado Y, Bittenbinder T, Papaconstantinou H. The impact of electronic medical record implementation on operating room efficiency. J Hospital Admin. 2015;5(1):48-51.

Campanella P, Lovato E, Marone C, Fallacara L, Mancuso A, Ricciardi W, et al. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Euro J Pub Heal. 2016;26(1):60-4.

Sanders D, Read-Brown S, Tu D, Lambert W, Choi D, Almario B, et al. Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing. JAMA Ophthalmol. 2014;132(5):586-92.

Nguyen L, Bellucci E, Nguyen L. Electronic health records implementation: An evaluation of information system impact and contingency factors. Int J Med Inform. 2014;83(11):79-796.

Chiang M, Read-Brown S, Tu D, Choi D, Sanders D, Hwang T, et al. Evaluation of electronic health record implementation in ophthalmology at an academic medical center (An American Ophthalmological Society Thesis). Transactions Am Ophthalmol Soci. 2013;111:70-92.

McDowell J, Wu A, Ehrenfeld J, Urman R. Effect of the Implementation of a New Electronic Health Record System on Surgical Case Turnover Time. J Med Systems. 2017;41(3):1-6.

Chan P, Thyparampil PJ, Chiang MF. Accuracy and speed of electronic health record versus paper-based ophthalmic documentation strategies. Am J Ophthalmol. 2013;156(1):165-72.

Attaallah AF, Elzamzamy OM, Phelps AL, Ranganthan P, Vallejo MC. Increasing operating room efficiency through electronic medical record analysis. J Perioper Pract. 2016;26(5):106-13.

Queensland Audit Office. Digitising public hospital (Report 10: 2018-19), 2018. Available at: https://www.qao.qld.gov.au/reports-parliament/digitising-public-hospitals.

Queensland Health. Queensland Health Digital Initiatives, 2019. Available at https://www.health.qld.gov.au/clinical-practice/innovation/ehealth/queensland. Accessed on 31 January 2019.

Fleming N, Culler S, Mccorkle R, Becker E, Ballard D, Fleming N. The financial and nonfinancial costs of implementing electronic health records in primary care practices. Health Affairs (Project Hope). 2011;30(3):481-9.

CDW Healthcare Survey: EHR Price Tag May Reach $120K Per Physician; Speeding Changes to Workflow Most Important Factor in Reducing Costs, 2010. Available at https://investor.cdw. com/news-releases/news-release-details/cdw-healthcare-survey-ehr-price-tag-may-reach-120k-physician. Accessed 1 January 2019.






Original Research Articles