Baron Richard J, Fabens Elizabeth L, Schiffman Melissa, Wolf Erica
Greenhouse Internists, P.C., Philadelphia, Pennsylvania 19119, USA.
Ann Intern Med. 2005 Aug 2;143(3):222-6. doi: 10.7326/0003-4819-143-3-200508020-00008.
We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment.
我们最近在我们独立的、由4名内科医生组成的社区普通内科诊所实施了一个功能齐全的电子健康记录系统。在从纸质记录过渡到计算机记录的过程中，我们遇到了各种挑战，有些是意想不到的。本文描述了使用电子健康记录对我们的财务、工作流程和办公环境所产生的影响。其财务影响并非明显积极；工作流程受到了极大干扰；而且办公环境质量最初对工作人员、医生和患者来说都大幅下降。话虽如此，我们没有人愿意再回到纸质健康记录，而且我们所有人都发现，这项技术有助于我们更好地满足患者期望，加快许多繁琐的工作流程（如开处方和撰写病历），并创造了新的方式来改善患者的健康状况。为了在小诊所成功实施电子健康记录，必须解决五个广泛的问题：融资；临床信息系统的互操作性、标准化和连接性；工作流程重新设计方面的帮助；技术支持和培训；以及变革管理方面的帮助。我们希望分享我们的经验能够让其他计划实施电子健康记录的人做好更充分的准备，并为政策制定者提供有关在小诊所环境中取得成功所需策略的信息。
