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基层医疗医生使用电子病历的经验:按服务收费环境下的实施障碍。

Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment.

作者信息

Ludwick D A, Doucette John

机构信息

Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8.

出版信息

Int J Telemed Appl. 2009;2009:853524. doi: 10.1155/2009/853524. Epub 2008 Dec 4.

DOI:10.1155/2009/853524
PMID:19081787
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2593889/
Abstract

Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation.

摘要

我们不断老龄化的人口加剧了卫生人力资源供需之间强烈且不同的趋势。减轻未来不平等状况的一种方法是采用卫生信息技术(HIT)。我们之前的研究表明了一些影响HIT实施成功的风险和缓解因素。我们通过对艾伯塔省九家诊所进行半结构化访谈证实了这些发现。社会技术因素显著影响了医生的实施成功。医生们报告称,时间限制降低了他们调查、采购和实施电子病历的意愿。过时的检查室设计、复杂的HIT用户界面、医生计算机技能不足,以及按服务收费薪酬模式和长等候名单导致的患者就诊紧迫性,即便没有影响信息交换的质量,也损害了其数量。在医生办公室系统实施期间,或许可以考虑采用替代性薪酬和服务获取计划来推动谨慎行为。

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本文引用的文献

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Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries.基层医疗中采用电子病历:从七个国家健康信息系统实施经验中吸取的教训
Int J Med Inform. 2009 Jan;78(1):22-31. doi: 10.1016/j.ijmedinf.2008.06.005. Epub 2008 Jul 21.
2
User satisfaction with EHRs: report of a survey of 422 family physicians.电子健康记录的用户满意度:422名家庭医生的调查结果报告
Fam Pract Manag. 2008 Feb;15(2):25-32.
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Improving quality through effective implementation of information technology in healthcare.
探索电子健康记录在沙特阿拉伯实施的促进因素。
BMC Med Inform Decis Mak. 2022 Dec 7;22(1):321. doi: 10.1186/s12911-022-02072-5.
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The effects of simulation training on learning of health information systems: A scoping review.模拟训练对健康信息系统学习的影响:一项范围综述。
J Educ Health Promot. 2022 Jan 31;11:4. doi: 10.4103/jehp.jehp_17_21. eCollection 2022.
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Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review.埃塞俄比亚采用电子病历系统的障碍:一项系统综述。
J Multidiscip Healthc. 2021 Sep 17;14:2597-2603. doi: 10.2147/JMDH.S327539. eCollection 2021.
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Methods for Large-Scale Quantitative Analysis of Scribe Impacts on Clinical Documentation.大规模定量分析抄写员对临床文档影响的方法。
AMIA Annu Symp Proc. 2021 Jan 25;2020:573-582. eCollection 2020.
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JMIR Med Inform. 2019 Nov 29;7(4):e13318. doi: 10.2196/13318.
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Usability Factors Associated With Physicians' Distress and Information System-Related Stress: Cross-Sectional Survey.与医生的困扰和信息系统相关压力相关的可用性因素:横断面调查。
JMIR Med Inform. 2019 Nov 5;7(4):e13466. doi: 10.2196/13466.
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Ranking the Meso Level Critical Factors of Electronic Medical Records Adoption Using Fuzzy Topsis Method.运用模糊理想解法对电子病历采用的中观层面关键因素进行排名
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Finnish physicians' stress related to information systems keeps increasing: a longitudinal three-wave survey study.芬兰医生与信息系统相关的压力不断增加:一项纵向三波调查研究。
BMC Med Inform Decis Mak. 2017 Oct 17;17(1):147. doi: 10.1186/s12911-017-0545-y.
通过在医疗保健领域有效实施信息技术来提高质量。
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