Epilepsy Programme, Department of Neurology, Beaumont Hospital, Dublin 9, Ireland.
Int J Med Inform. 2010 May;79(5):349-60. doi: 10.1016/j.ijmedinf.2010.01.013. Epub 2010 Feb 23.
Examination of electronic patient record (EPR) implementation at the socio-technical interface. This study was based on the introduction of an anti-epileptic drug (AED) management module of an EPR in an epilepsy out-patient clinic. The objective was to introduce the module to a live clinical setting within strictly controlled conditions to evaluate its usability and usefulness.
Qualitative and quantitative methods were employed in an observational field study. A purposeful sample of specialists in epilepsy care (2 doctors and 2 nurses) was recruited. Perception of usefulness and ease of use of the AED module, impact on work processes, and accuracy of use were evaluated using feedback meetings, evaluation forms, ethnographic analysis and data validation techniques. Emerging issues were grouped into three key themes: human, organisational and technological.
The electronic patient record use was studied for 49 patients over the course of 18 out-patient clinics. While participants varied in their approach to interacting with the AED module, they expressed satisfaction with its usability and performance. The necessary co-existence of the paper and electronic record, and changes to customary work practice were considered the biggest challenges. 82% accuracy in the use of the electronic record was determined.
Achieving successful electronic patient record implementation is complex. While technical challenges exist, it is possibly more important to acknowledge the social considerations. Initially, an increase in medical record fragmentation and disruption to workflow can arise with the introduction of the technology. Realising the benefits of electronic patient records will require the management of a lengthy transition phase.
考察电子病历（EPR）在社会技术界面的实施情况。本研究基于在癫痫门诊引入 EPR 的抗癫痫药物（AED）管理模块。目的是在严格控制的条件下将该模块引入实际临床环境，以评估其可用性和实用性。
采用定性和定量方法进行观察性现场研究。招募了 2 名癫痫护理专家（2 名医生和 2 名护士）作为目的样本。通过反馈会议、评估表、民族志分析和数据验证技术，评估了 AED 模块的使用感知、易用性、对工作流程的影响以及使用准确性。将出现的问题分为三个关键主题：人为因素、组织因素和技术因素。
在 18 次门诊期间，对 49 名患者的电子病历使用情况进行了研究。虽然参与者在与 AED 模块交互的方式上存在差异，但他们对其可用性和性能表示满意。纸质病历和电子病历的共存以及对常规工作实践的改变被认为是最大的挑战。电子病历的使用准确率为 82%。
成功实施电子病历是复杂的。虽然存在技术挑战，但承认社会因素可能更为重要。最初，随着技术的引入，病历可能会更加碎片化，工作流程也可能会中断。要实现电子病历的好处，需要管理一个漫长的过渡阶段。
