Hertzum Morten, Simonsen Jesper
Computer Science, Roskilde University, Roskilde, Denmark.
Int J Med Inform. 2008 Dec;77(12):809-17. doi: 10.1016/j.ijmedinf.2008.03.006. Epub 2008 May 23.
To investigate the effects of a fully functional electronic patient record (EPR) system on clinicians' work during team conferences, ward rounds, and nursing handovers.
In collaboration with clinicians an EPR system was configured for a stroke unit and in trial use for 5 days, 24h a day. During the trial period the EPR system was used by all clinicians at the stroke unit and it replaced all paper records. The EPR system simulated a fully integrated clinical-process EPR where the clinicians experienced the system as if all transactions were IT supported. Such systems are not to be expected to be in operational use in Denmark until at least 2 years from now. The EPR system was evaluated with respect to its effects on clinicians' mental workload, overview, and need for exchanging information. Effects were measured by comparing the use of electronic records with the use of paper records prior to the trial period. The data comprise measurements from 11 team conferences, 7 ward rounds, and 10 nursing handovers.
During team conferences the clinicians experienced a reduction on five of six subscales of mental workload, and the physicians experienced an overall reduction in mental workload. The physician in charge also experienced increased clarity about the importance of and responsibilities for work tasks, and reduced mental workload during ward rounds. During nursing handovers the nurses experienced fewer missing pieces of information and fewer messages to pass on after the handover. Further, the status of the nursing plans for each patient was clearer for all nurses at the nursing handovers except the nurse team leader, who experienced less clarity about the status of the plans.
The clinicians experienced positive effects of electronic records over paper records for the three clinical activities involved in the evaluation. This is important in its own right and likely to affect clinicians' acceptance of EPR systems, their command of their work, and consequently the attainment of 'downstream' effects on patient outcomes.
探讨功能完备的电子病历（EPR）系统在团队会议、病房查房及护理交接班期间对临床医生工作的影响。
与临床医生合作，为一个卒中单元配置了一套EPR系统，并进行了为期5天、每天24小时的试用。在试用期间，卒中单元的所有临床医生都使用了EPR系统，它取代了所有纸质记录。该EPR系统模拟了一个完全集成的临床流程电子病历，临床医生体验该系统时就好像所有操作都有信息技术支持一样。预计此类系统至少要到两年后才会在丹麦投入实际使用。对EPR系统在临床医生心理工作量、全局把控及信息交流需求方面的影响进行了评估。通过对比试用前电子记录与纸质记录的使用情况来衡量其效果。数据包括11次团队会议、7次病房查房及10次护理交接班的测量结果。
在团队会议期间，临床医生在心理工作量的六个子量表中的五个上体验到了减轻，医生们整体心理工作量有所减少。负责医生在病房查房期间也体验到对工作任务的重要性和职责的清晰度提高，心理工作量减轻。在护理交接班期间，护士们交接后发现遗漏信息更少，需要传递的信息也更少。此外，除了护士组长外，所有护士在护理交接班时对每位患者护理计划的状态都更清楚了，而护士组长对计划状态的清晰度有所降低。
对于评估中涉及的三项临床活动，临床医生体验到电子记录相对于纸质记录具有积极影响。这本身就很重要，并且可能会影响临床医生对EPR系统的接受度、他们对工作的掌控，进而影响对患者预后的“下游”效应的实现。
