Simon Steven R, Kaushal Rainu, Cleary Paul D, Jenter Chelsea A, Volk Lynn A, Orav E John, Burdick Elisabeth, Poon Eric G, Bates David W
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Arch Intern Med. 2007 Mar 12;167(5):507-12. doi: 10.1001/archinte.167.5.507.
Electronic health records (EHRs) allow for a variety of functions, ranging from visit documentation to laboratory test ordering, but little is known about physicians' actual use of these functions.
We surveyed a random sample of 1884 physicians in Massachusetts by mail and assessed availability and use of EHR functions, predictors of use, and the relationships between EHR use and physicians' perceptions of medical practice.
A total of 1345 physicians responded to the survey (71.4% response rate), and 387 (28.8%) reported that their practice had adopted EHRs. More than 80% of physicians with EHRs reported having the ability to view laboratory reports (84.8%) and document visits electronically (84.0%), but considerably fewer reported being able to order laboratory tests electronically (46.8%) or transmit prescriptions to a pharmacy electronically (44.7%). Fewer than half of the physicians who had systems with clinical decision support, transmittal of electronic prescriptions, and radiology order entry actually used these functions most or all of the time. Compared with physicians who had not adopted EHRs, EHR users reported more positive views of the effects of computers on health care; there were no significant differences in these attitudes between high and low users of EHRs. Overall, about 1 in 4 physicians reported dissatisfaction with medical practice; there was no difference in this measure by EHR adoption or use.
There is considerable variability in the functions available in EHRs and in the extent to which physicians use them. Future work should emphasize factors that affect the use of available functions.
电子健康记录（EHRs）具备多种功能，从就诊记录到实验室检查医嘱等，但对于医生对这些功能的实际使用情况却知之甚少。
我们通过邮件对马萨诸塞州1884名医生进行了随机抽样调查，评估了EHR功能的可用性和使用情况、使用的预测因素，以及EHR使用与医生对医疗实践看法之间的关系。
共有1345名医生回复了调查（回复率为71.4%），其中387名（28.8%）报告其诊所采用了EHRs。超过80%拥有EHRs的医生报告能够查看实验室报告（84.8%）并进行电子就诊记录（84.0%），但报告能够进行电子实验室检查医嘱的医生要少得多（46.8%），能够将处方电子传输到药房的医生也较少（44.7%）。在拥有临床决策支持、电子处方传输和放射学检查医嘱录入系统的医生中，不到一半的人实际上大部分或全部时间都在使用这些功能。与未采用EHRs的医生相比，EHR用户对计算机对医疗保健影响的看法更为积极；EHR高用户和低用户在这些态度上没有显著差异。总体而言，约四分之一的医生报告对医疗实践不满意；在这一指标上，EHR的采用或使用情况并无差异。
EHRs中的可用功能以及医生对其的使用程度存在很大差异。未来的工作应强调影响可用功能使用的因素。
