Kralewski John E, Dowd Bryan E, Cole-Adeniyi Titilope, Gans Dave, Malakar Lucy, Elson Bob
Division of Health Policy and Management, University of Minnesota, Minneapolis, USA. krale001@umn
Health Care Manage Rev. 2008 Oct-Dec;33(4):361-7. doi: 10.1097/01.HCM.0000318773.67395.ce.
A major factor limiting efficiency and quality gains from clinical information technologies is the lack of full use by the clinicians.
To identify the practice and physician characteristics that influence the use of e-scripts after adoption.
Data were obtained from 27 primary care medical group practices that had e-script technology for 2 years. Physician and practice characteristics were obtained from the clinics, and the proportion of each physician's prescriptions sent electronically was calculated from the prescription records. Practice culture data were obtained from a survey of the physicians in each practice. Data were analyzed using hierarchal regression.
Practice-level variables explain most of the variance in the use of e-scripts by physicians, although there are significant differences in use among specialties as well. General internists have slightly lower use rates and pediatricians have the highest rates. Larger practices and multispecialty practices have higher use rates, and five practice culture dimensions influence these rates; two have a negative influence and three (organizational trust, adaptive, and a business orientation) have a positive influence.
While previous studies have identified physician characteristics and product deficiencies as factors limiting the use of electronic information technologies in medical practices, our data indicate that the influence of these factors may be highly dependent on the culture of the practice. Consequently, practice administrators can improve physician acceptance and use of these technologies by making sure that there is a culture/technology fit before deciding on a product.
限制临床信息技术效率和质量提升的一个主要因素是临床医生未充分利用这些技术。
确定在采用电子处方后影响其使用的实践和医生特征。
数据来自27个采用电子处方技术达两年的基层医疗集团实践。从诊所获取医生和实践特征，并根据处方记录计算每位医生电子发送处方的比例。实践文化数据来自对每个实践中医生的调查。使用层次回归分析数据。
实践层面的变量解释了医生使用电子处方的大部分差异，尽管各专业之间的使用也存在显著差异。普通内科医生的使用率略低，儿科医生的使用率最高。规模较大的实践和多专业实践的使用率较高，有五个实践文化维度影响这些使用率；两个有负面影响，三个（组织信任、适应性和商业导向）有正面影响。
虽然先前的研究已将医生特征和产品缺陷确定为限制医疗实践中电子信息技术使用的因素，但我们的数据表明，这些因素的影响可能高度依赖于实践文化。因此，实践管理人员在决定采用某种产品之前，可通过确保文化与技术相匹配来提高医生对这些技术的接受度和使用率。
