The Netherlands Organization for Applied Scientific Research (TNO), Department Quality of Life, Leiden, The Netherlands.
Int J Med Inform. 2010 Sep;79(9):623-36. doi: 10.1016/j.ijmedinf.2010.06.001. Epub 2010 Jul 6.
A locum practitioner is an out-of-hours general practitioner who needs access to the electronic health record of visiting patients. The electronic locum record is a summary of the electronic health record available to the locum practitioner and includes the most significant health problems, the most recent records of the patient's visits to the practice, current medication data and information on allergies and intolerances. The locum practitioner returns a locum medical note to the electronic health record at the general practitioner with his or her diagnosis, treatment or referral of the visiting patient. A pilot project of the electronic locum record was implemented in the Twente region of the Netherlands.
To obtain policy information for the nationwide implementation of the electronic locum record as a first component of the electronic health record in the Netherlands.
First, evaluation aspects were collected from parties involved in the pilot implementation process. Aspects were taken from the work flow to operationalise the electronic health record. Secondly, indicator questions were formulated and normative levels agreed for each indicator by a panel with experts from the medical and information technology domain. Third, the actual values were rated either by measurement (technical indicators) or by structured interviews (process indicators) with the general practitioners who joined the pilot study. Finally, a cross case analysis was performed by checking for (in-)consistencies among the respondents.
Eight out of the 15 key indicators scored positive, three failed and four remained inconclusive. The indicators that failed the norms related to the guideline for electronic registration of patient information, the process of acquiring the healthcare professional identification card and card-related services. Indicators that remained inconclusive referred to storing and archiving of identification cards and codes, the use of the identification repository at the general practice post and the usefulness and ease-of-use of the electronic locum record.
The study demonstrates that many processes, systems, services and practices for nation-wide implementation of the electronic locum record for general practitioners in the Netherlands are in place. However, significant improvements are required on a number of aspects. For example general practitioners need to be trained more in applying the guideline for electronic registration of patient data. Also the process for general practitioners to acquire their unique healthcare professional identification cards should require less effort. We also recommend that a strong regional information technology support group should be in operation during roll-out.
驻场医生是一名非工作时间的全科医生，需要访问患者的电子健康记录。电子驻场记录是驻场医生可获得的电子健康记录的摘要，其中包括最显著的健康问题、患者最近到诊所就诊的记录、当前用药数据以及过敏和不耐受信息。驻场医生会根据访问患者的诊断、治疗或转诊情况，向全科医生返回驻场医疗记录。电子驻场记录的试点项目在荷兰特文特地区实施。
为荷兰全国范围内实施电子驻场记录作为电子健康记录的第一个组成部分获取政策信息。
首先，从参与试点实施过程的各方收集评估方面。从工作流程中获取操作电子健康记录的方面。其次，由来自医学和信息技术领域的专家组成的专家组制定指标问题，并为每个指标商定规范水平。第三，通过对参加试点研究的全科医生进行测量（技术指标）或结构化访谈（过程指标）来对实际值进行评分。最后，通过检查受访者之间的（不一致）来进行跨案例分析。
15 个关键指标中有 8 个指标得分积极，3 个指标失败，4 个指标不确定。不符合规范的指标与电子登记患者信息指南、获取医疗保健专业识别卡的流程以及与卡相关的服务有关。不确定的指标涉及识别卡和代码的存储和存档、在全科医生岗位使用识别存储库以及电子驻场记录的有用性和易用性。
该研究表明，荷兰为全科医生实施全国范围的电子驻场记录的许多流程、系统、服务和实践已经就绪。然而，还需要在许多方面进行重大改进。例如，需要对全科医生进行更多关于应用电子患者数据登记指南的培训。此外，全科医生获取其独特医疗保健专业识别卡的流程也应该更加简化。我们还建议，在推出阶段，应该有一个强大的区域信息技术支持小组在运作。
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