DesRoches Catherine M, Campbell Eric G, Rao Sowmya R, Donelan Karen, Ferris Timothy G, Jha Ashish, Kaushal Rainu, Levy Douglas E, Rosenbaum Sara, Shields Alexandra E, Blumenthal David
Institute for Health Policy, Massachusetts General Hospital, Boston 02114, USA.
N Engl J Med. 2008 Jul 3;359(1):50-60. doi: 10.1056/NEJMsa0802005. Epub 2008 Jun 18.
Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption.
In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices.
Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.
Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.
电子健康记录有改善医疗服务提供的潜力。然而，在美国，医生采用此类系统的速度一直较慢。本研究评估了医生对门诊电子健康记录的采用情况、他们对此类系统的满意度、对系统对医疗质量的感知影响以及采用的感知障碍。
在2007年末和2008年初，我们对2758名医生进行了全国性调查，回复率为62%。使用基于专家共识的电子健康记录定义，我们确定了在办公室环境中使用此类记录的医生比例以及采用情况与个体医生及其执业特征之间的关系。
4%的医生报告拥有广泛、功能齐全的电子记录系统，13%的医生报告拥有基本系统。在多变量分析中，初级保健医生以及在大型团体、医院或医疗中心执业且在美国西部地区执业的医生更有可能使用电子健康记录。医生报告这些系统在医疗质量的几个方面有积极影响且满意度较高。财务障碍被认为对采用电子健康记录的决策影响最大。
使用电子健康记录的医生认为此类系统可提高医疗质量且总体上对系统满意。然而，截至2008年初，只有一小部分美国医生采用了电子系统，这些医生可能与后来采用这些系统的医生不同。
