电子健康记录：哪些医疗机构拥有它们，临床医生又是如何使用它们的？
Electronic health records: which practices have them, and how are clinicians using them?
作者信息
Simon Steven R, McCarthy Madeline L, Kaushal Rainu, Jenter Chelsea A, Volk Lynn A, Poon Eric G, Yee Kevin C, Orav E John, Williams Deborah H, Bates David W
机构信息
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
出版信息
J Eval Clin Pract. 2008 Feb;14(1):43-7. doi: 10.1111/j.1365-2753.2007.00787.x.
BACKGROUND
Limited data exist to estimate the use of electronic health records (EHRs) in ambulatory care practices in the United States.
METHODS
We surveyed a stratified random sample of 1829 office practices in Massachusetts in 2005. The one-page survey measured use of health information technology, plans for EHR adoption and perceived barriers to adoption.
RESULTS
A total of 847 surveys were returned, for a response rate of 46%. Overall, 18% of office practices reported having an EHR. Primary-care-only and mixed practices reported similar adoption rates (23% and 25%, respectively, P = 0.70). The adoption rate in specialty practices (14%) was lower compared with both primary-care-only (P < 0.01) and mixed (P < 0.05) practices. The number of clinicians in the practice strongly correlated with EHR adoption (P < 0.001), with fewer small practices adopting EHRs. Among practices that have EHRs with laboratory and radiology result retrieval capabilities, at least 87% of practices report that a majority of their clinicians actively use these functionalities, while 74% of practices with electronic decision support report that the majority of clinicians actively use it. Among the practices without an EHR, 13% plan to implement one within the next 12 months, 24% within the next 1-2 years, 11% within the next 3-5 years, and 52% reported having no plans to implement an EHR in the foreseeable future. The most frequently reported barrier to implementation was lack of adequate funding (42%).
CONCLUSIONS
Overall, fewer than 1 in 5 medical practices in Massachusetts have an EHR. Even among adopters, though, doctor usage of EHR functions varied considerably by functionality and across practices. Many clinicians are not actively using functionalities that are necessary to improve health care quality and patient safety. Furthermore, among practices that do not have EHRs, more than half have no plan for adoption. Inadequate funding remains an important barrier to EHR adoption in ambulatory care practices in the United States.
背景
在美国，用于评估门诊医疗实践中电子健康记录（EHR）使用情况的数据有限。
方法
2005年，我们对马萨诸塞州1829家门诊进行了分层随机抽样调查。这份单页调查问卷测量了健康信息技术的使用情况、EHR采用计划以及采用过程中感知到的障碍。
结果
共收回847份调查问卷，回复率为46%。总体而言，18%的门诊报告拥有EHR。仅提供初级保健服务的门诊和综合门诊报告的采用率相似（分别为23%和25%，P = 0.70）。专科门诊的采用率（14%）低于仅提供初级保健服务的门诊（P < 0.01）和综合门诊（P < 0.05）。门诊中临床医生的数量与EHR的采用密切相关（P < 0.001），小型门诊采用EHR的较少。在具备实验室和放射学检查结果检索功能的EHR门诊中，至少87%的门诊报告称其大多数临床医生积极使用这些功能，而在具备电子决策支持功能的门诊中，74%报告称大多数临床医生积极使用该功能。在没有EHR的门诊中，13%计划在未来12个月内实施，24%计划在未来1至2年内实施，11%计划在未来3至5年内实施，52%报告在可预见的未来没有实施EHR的计划。最常报告的实施障碍是资金不足（42%）。
结论
总体而言，马萨诸塞州不到五分之一的医疗门诊拥有EHR。然而，即使在采用者中，医生对EHR功能的使用在不同功能和不同门诊之间也存在很大差异。许多临床医生并未积极使用那些对提高医疗质量和患者安全至关重要的功能。此外，在没有EHR的门诊中，超过一半没有采用计划。资金不足仍然是美国门诊医疗实践中采用EHR的一个重要障碍。
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