无纸质病历，但流程依旧：对挪威两家停用纸质病历医院的体验进行定性探索
No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record.
作者信息
Lium Jan-Tore, Tjora Aksel, Faxvaag Arild
机构信息
Department of Industrial Economics and Technology Management, and Norwegian Research Centre for Electronic Patient Records, Norwegian University of Science and Technology (NTNU), Norway.
出版信息
BMC Med Inform Decis Mak. 2008 Jan 10;8:2. doi: 10.1186/1472-6947-8-2.
BACKGROUND
It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment.
METHODS
Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals.
RESULTS
Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems.
CONCLUSION
Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system.
背景
研究表明，实施电子病历（EMR）并停用纸质病历是可行的，但这代表着医院医生信息环境的巨大变化。此前的调查显示，电子病历系统的使用和用户满意度在医院之间存在很大差异。本研究的目的是进一步探讨电子病历系统实施过程后临床医生工作的变化，以及他们在无纸质信息环境中的工作体验。
方法
基于对挪威两家医院医生进行的18次半结构化访谈的定性研究。
结果
确定了基于电子病历实践中工作的10个不同但相关的特征；（1）在实施过程中临床与行政合作更紧密；（2）每个人都使用该系统时效益更大；（3）系统对新手的支持比对有经验的医生更好；（4）电子病历对专业学习有用；（5）新用户由有经验的人员介绍系统；（6）年轻临床医生与资深临床医生的态度不同，但这可能不仅仅与年龄和以前的计算机使用经验有关；（7）电子病历使生成自由文本记录更容易，但这也造成了信息过载的可能性；（8）对移动工作的支持很少或没有；（9）仍会遇到停机情况，这影响了对系统的态度；（10）与纸质和电子混合系统相比，临床医生更喜欢仅使用电子病历。
结论
尽管临床工作流程中取消了纸质记录（医院临床医生认为这一变化非常有用），但许多旧的常规做法仍未改变，限制了电子病历系统的潜力。因此，不仅需要从物理意义上消除纸张，还需要建立常规做法，以充分实现电子病历系统的效益。
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