As Electronic Medical Records (EMRs) have a great possibility for rising physician's performance in their daily work which improves quality, safety and efficiency in healthcare, they are implemented throughout the world (Boonstra and Broekhuis, 2010). In physician practices the rate of EMRs adoption has been slow and restricted (around 25%) according to Endsley, Baker, Kershner, and Curtin (2005) in spite of the cost savings through lower administrative costs and medical errors related with EMRs systems. The core objective of this research is to identify, categorize, and analyse meso-level factors introduced by Lau et al, 2012, perceived by physicians to the adoption of EMRs in order to give more knowledge in primary care setting. Finding was extracted through questionnaire which distributed to 350 physicians in primary cares in Malaysia to assess their perception towards EMRs adoption. The findings showed that Physicians had positive perception towards some features related to technology adoption success and emphasized EMRs had helpful impact in their office. The fuzzy TOPSIS physician EMRs adoption model in meso-level developed and its factors and sub-factors discussed in this study which provide making sense of EMRs adoption. The related factors based on meso-level perspective prioritized and ranked by using the fuzzy TOPSIS. The purpose of ranking using these approaches is to inspect which factors are more imperative in EMRs adoption among primary care physicians. The result of performing fuzzy TOPSIS is as a novelty method to identify the critical factors which assist healthcare organizations to inspire their users in accepting of new technology.
A study was undertaken amongst private primary care providers in three urban centres of Malaysia to understand the organizational structure of the facilities and to assess the cost of running such services. A total of 150 clinics were involved in the study. Data was collected through interviews with owners of the clinics using semi-structured questionnaires. Solo-practitioners owned 64.7% of the clinics while 35.3% of them were owned by group practice. This study showed that the mean number of patients visited the clinics daily was 49.3 with the average operating hours of 79.4 hours/week (range 28.0 - 168.0 hours/week). Group practice clinics operates 23.9 hours longer than solo-practice clinics. Group practice clinics were more likely to offer 24 hours service than solo-practice clinics. Most of the clinics were manned by a single doctor (57.3%), 30.0 % had two doctors and only 12.7% were run by more than two doctors. On average, group practice employed greater number of supporting staff than solo-practice clinics (6.0 vs 4.3 people). The mean annual cost to run each facility was found to be RM 444,698. The mean cost per patient was found to be RM 32.09 for solo-practice clinics and RM 38.55 for group practice. Wages represented the highest proportion in the recurrent cost (61.1%) followed by drugs (29.2%) and consumables (2.7%). Building cost (67.9%) and equipment cost (25.9%) were the major capital costs for the clinics. This study could serve as a basis to reimburse private primary care providers in the future health financing scheme in Malaysia. To improve efficiency and contain cost in primary care settings, efforts should be targeted towards cost of wages and drugs utilised by the providers in their daily practice.
Key words: Private practice; primary care; costs; Malaysia.