Boyer L, Renaud M-H, Limousin S, Henry J-M, Caïetta P, Fieschi M, Samuelian J-C
Unité D'information Médicale en Psychiatrie, Service de Santé Publique et D'information Médicale, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, Marseille, France.
Encephale. 2009 Oct;35(5):454-60. doi: 10.1016/j.encep.2008.06.010. Epub 2008 Sep 30.
The aim of this study was to evaluate the interest taken by the health care providers in the electronic medical file and its use within the quality improvement process.
Our institution is a 204-bed psychiatric hospital, employing 328 professionals and comprising three sectors: six units of complete hospitalisation (102 beds), one unit of week hospitalisation (15 beds), one unit of emergency (7 beds) and one unit of night hospitalisation (15 beds). Three extrahospital structures include the day hospitalisation (65 places), the medicopsychological centers (CMP) and the part-time therapeutic reception centers (CATTP) of the three sectors.
We conducted face-to-face, semi-structured interviews with health care providers of a public psychiatric hospital. All the solicited people agreed to answer the investigation. The interviews were conducted until no new ideas emerged in the content analysis performed in real time, comprising 60 care providers: 10 psychiatrists, 42 nurses and eight paramedical professionals. Content analysis was performed by two members of the steering committee who were skilled in textual analysis. A descriptive analysis was also performed. The variables were described by proportions and means. The proportions were compared using the Chi-squared test or Fisher exact test where appropriate. A two-tailed P-value of greater than 0.05 was considered to indicate statistical significance. Statistical analyses were carried out using SPSS version 13.0.
Ninety-six percent of the interviewed subjects used the electronic medical file. The average number of daily use was seven (S.D.=5). Sixty-seven percent had a favorable opinion of the electronic medical file. Physicians had more frequent favorable opinions than nurses who considered that electronic medical files cannot capture real nursing activity. Health care providers considered that electronic medical file could be associated with improved quality of care, but two points should be taken into account: the increased documentation time (slow system response, multiple screens, the lack of computer knowledge, the absence of bedside documentation technology...) and dysfunctions in the information processing system. This could have an impact on documentation completeness, and quality and could also lead to a reduction of time devoted to care.
This study proposes tracks of improvement in the use of the DPIP. In spite of this, a true debate must be initiated on these new information systems in psychiatry since their real objectives can be perceived as ambiguous, so that programs of clarification, education and reinsurance can be set-up.
本研究旨在评估医疗服务提供者对电子病历的兴趣及其在质量改进过程中的使用情况。
我们的机构是一家拥有204张床位的精神病医院，雇佣了328名专业人员，包括三个部门：六个完整住院单元（102张床位）、一个周住院单元（15张床位）、一个急诊单元（7张床位）和一个夜间住院单元（15张床位）。三个院外机构包括日间住院部（65个床位）、三个部门的医学心理中心（CMP）和兼职治疗接待中心（CATTP）。
我们对一家公立精神病医院的医疗服务提供者进行了面对面的半结构化访谈。所有被邀请的人都同意回答调查。访谈一直进行到实时内容分析中不再出现新想法为止，共访谈了60名医疗服务提供者：10名精神科医生、42名护士和8名辅助医疗专业人员。内容分析由指导委员会中两名擅长文本分析的成员进行。还进行了描述性分析。变量用比例和均值进行描述。在适当情况下，使用卡方检验或Fisher精确检验比较比例。双侧P值大于0.05被认为具有统计学意义。使用SPSS 13.0版进行统计分析。
96%的受访对象使用电子病历。每日平均使用次数为7次（标准差=5）。67%的人对电子病历持赞成态度。医生比护士更频繁地持赞成态度，护士认为电子病历无法记录真实的护理活动。医疗服务提供者认为电子病历可能与护理质量的提高相关，但有两点需要考虑：记录时间增加（系统响应缓慢、多个屏幕、缺乏计算机知识、缺乏床边记录技术……）以及信息处理系统中的功能障碍。这可能会影响记录的完整性和质量，也可能导致用于护理的时间减少。
本研究提出了改进电子病历使用的方向。尽管如此，由于这些新信息系统的真正目标可能被认为不明确，因此必须在精神病学领域就这些新信息系统展开真正的辩论，以便能够建立澄清、教育和再保险计划。
