Orchard Margo C, Dobrow Mark J, Paszat Lawrence, Jiang Hedy, Brown Patrick
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, M5J 2P1, Canada.
BMC Med Inform Decis Mak. 2009 Aug 10;9:38. doi: 10.1186/1472-6947-9-38.
The use of electronic health records (EHRs) to support the organization and delivery of healthcare is evolving rapidly. However, little is known regarding potential variation in access to EHRs by provider type or care setting. This paper reports on observed variation in the perceptions of access to EHRs by a wide range of cancer care providers covering diverse cancer care settings in Ontario, Canada.
Perspectives were sought regarding EHR access and health record completeness for cancer patients as part of an internet survey of 5663 cancer care providers and administrators in Ontario. Data were analyzed using a multilevel logistic regression model. Provider type, location of work, and access to computer or internet were included as covariates in the model.
A total of 1997 of 5663 (35%) valid responses were collected. Focusing on data from cancer care providers (N = 1247), significant variation in EHR access and health record completeness was observed between provider types, location of work, and level of computer access. Providers who worked in community hospitals were half as likely as those who worked in teaching hospitals to have access to their patients' EHRs (OR 0.45 95% CI: 0.24-0.85, p < 0.05) and were six times less likely to have access to other organizations' EHRs (OR 0.15 95% CI: 0.02-1.00, p < 0.05). Compared to surgeons, nurses (OR 3.47 95% CI: 1.80-6.68, p < 0.05), radiation therapists/physicists (OR 7.86 95% CI: 2.54-25.34, p < 0.05), and other clinicians (OR 4.92 95% CI: 2.15-11.27, p < 0.05) were more likely to report good access to their organization's EHRs.
Variability in access across different provider groups, organization types, and geographic locations illustrates the fragmented nature of EHR adoption in the cancer system. Along with focusing on technological aspects of EHR adoption within organizations, it is essential that there is cross-organizational and cross-provider access to EHRs to ensure patient continuity of care, system efficiency, and high quality care.
利用电子健康记录（EHRs）来支持医疗保健的组织和提供正在迅速发展。然而，对于不同类型的医疗服务提供者或医疗环境中获取电子健康记录的潜在差异知之甚少。本文报告了加拿大安大略省涵盖多种癌症护理环境的广泛癌症护理提供者对获取电子健康记录的看法中观察到的差异。
作为对安大略省5663名癌症护理提供者和管理人员的互联网调查的一部分，征求了关于癌症患者电子健康记录获取和健康记录完整性的意见。使用多级逻辑回归模型分析数据。模型中的协变量包括提供者类型、工作地点以及计算机或互联网的使用情况。
共收集到5663份有效回复中的1997份（35%）。聚焦于癌症护理提供者的数据（N = 1247），观察到不同提供者类型、工作地点和计算机使用水平在电子健康记录获取和健康记录完整性方面存在显著差异。在社区医院工作的提供者能够访问其患者电子健康记录的可能性只有在教学医院工作的提供者的一半（OR 0.45，95% CI：0.24 - 0.85，p < 0.05），并且能够访问其他组织电子健康记录的可能性要低六倍（OR 0.15，95% CI：0.02 - 1.00，p < 0.05）。与外科医生相比，护士（OR 3.47，95% CI：1.80 - 6.68，p < 0.05）、放射治疗师/物理学家（OR 7.86，95% CI：2.54 - 25.34，p < 0.05）和其他临床医生（OR 4.92，95% CI：2.15 - 11.27，p < 0.05）更有可能报告能够很好地访问其所在组织的电子健康记录。
不同提供者群体、组织类型和地理位置之间获取电子健康记录的差异说明了癌症系统中电子健康记录采用的碎片化性质。除了关注组织内部电子健康记录采用的技术方面外，跨组织和跨提供者获取电子健康记录对于确保护理的连续性、系统效率和高质量护理至关重要。
