Beiter Patrick A, Sorscher Jonathan, Henderson Carol J, Talen Mary
Inform Prim Care. 2008;16(3):221-7. doi: 10.14236/jhi.v16i3.697.
Electronic medical records (EMRs) are the future of primary care. Transition to electronic records can have a significant impact on physicians, office staff, nursing staff and patients. There are no published EMR studies combining these four populations or studies that have evaluated the impact of EMR demonstrations. To better understand the impact of EMRs, an online survey was administered before and after EMR demonstrations.
A longitudinal cohort survey design was used to assess primary outcomes (attitudes, knowledge, skills and needs) related to EMRs in four populations that were divided into two groups--one of physicians and the other of nursing staff, office staff and patients. A total of 39 participants (19 physicians and 20 staff/patients) completed a pretest survey four weeks prior to and post-test surveys at four and ten weeks after EMR demonstrations. Mean composite scores for each primary outcome were calculated for each group and mean differences were calculated and compared within and between groups--from baseline to four weeks and four to ten weeks using paired t-tests and Student's t-tests, respectively.
Groups differed in several areas: physicians were younger, had more education and had fewer years of experience in a primary care office. There were no significant differences in gender or computer experience between groups. Staff/patients reported significant improvements in attitudes, knowledge and needs from baseline to four weeks (P<0.05, P<0.01 and P<0.05). Physician attitudes, knowledge and needs significantly increased at week four (P<0.05, P<0.01 and P<0.05). Attitudes, knowledge and needs were sustained in both groups from week four through to week ten.
EMR demonstrations improved attitudes, knowledge and needs of staff/patients and physicians. EMR demonstrations may be effective in favorably influencing healthcare personnel towards EMRs.
电子病历（EMR）是初级医疗的未来发展方向。向电子病历的转变会对医生、办公室工作人员、护理人员和患者产生重大影响。目前尚无已发表的将这四类人群纳入研究范围的电子病历研究，也没有评估电子病历演示影响的研究。为了更好地了解电子病历的影响，在电子病历演示前后开展了一项在线调查。
采用纵向队列调查设计，评估四类人群与电子病历相关的主要结果（态度、知识、技能和需求），这四类人群分为两组，一组是医生，另一组是护理人员、办公室工作人员和患者。共有39名参与者（19名医生和20名工作人员/患者）在电子病历演示前四周完成了预测试调查，并在演示后四周和十周完成了后测试调查。计算每组每个主要结果的平均综合得分，并计算平均差异，分别使用配对t检验和学生t检验比较组内和组间从基线到四周以及四周到十周的差异。
两组在几个方面存在差异：医生更年轻，受教育程度更高，在初级医疗办公室的工作经验年限更少。两组在性别或计算机使用经验方面没有显著差异。工作人员/患者报告称，从基线到四周，他们在态度、知识和需求方面有显著改善（P<0.05、P<0.01和P<0.05）。在第四周，医生的态度、知识和需求显著增加（P<0.05、P<0.01和P<0.05）。从第四周到第十周，两组的态度、知识和需求都保持稳定。
电子病历演示改善了工作人员/患者和医生的态度、知识和需求。电子病历演示可能有效地使医护人员对电子病历产生积极态度。
