Ward Marcia M, Vartak Smruti, Schwichtenberg Tammy, Wakefield Douglas S
Department of Health Management and Policy, University of Iowa, Iowa City, USA.
Comput Inform Nurs. 2011 Sep;29(9):502-11. doi: 10.1097/NCN.0b013e31822b8798.
There is a little evidence of the impact of clinical information system implementation on nurses' workflow and patient care to guide institutions across the nation as they implement electronic health records. This study compared changes in nurse's perceptions about patient care processes and workflow before and after a comprehensive clinical information system implementation at a rural referral hospital. The study used the Information Systems Expectations and Experiences survey, which consists of seven scales-provider-patient communication, interprovider communication, interorganizational communication, work-life changes, improved care, support and resources, and patient care processes. Survey responses were examined across three administrations-before and after training and after implementation. The survey responses decreased significantly for eight of the 47 survey items from the first administration to the second and for 37 items from the second administration to the third. Perceptions were more positive in nurses who had previous experience with electronic health records and less positive in nurses with more years of work experience. These findings point to the importance of setting realistic expectations, assessing user perceptions throughout the implementation process, designing training to meet the needs of the end user, and adapting training and implementation processes to support nurses who have concerns.
关于临床信息系统的实施对护士工作流程和患者护理的影响，几乎没有证据可指导全国各机构实施电子健康记录。本研究比较了一家农村转诊医院全面实施临床信息系统前后护士对患者护理流程和工作流程看法的变化。该研究使用了信息系统期望与体验调查，该调查由七个量表组成——医患沟通、医护人员间沟通、组织间沟通、工作生活变化、护理改善、支持与资源以及患者护理流程。在培训前、培训后和实施后这三个阶段对调查回复进行了检查。从第一次调查到第二次调查，47个调查项目中有8个的调查回复显著下降，从第二次调查到第三次调查，有37个项目的调查回复显著下降。有电子健康记录使用经验的护士看法更为积极，而工作年限较长的护士看法则没那么积极。这些发现表明设定现实期望、在整个实施过程中评估用户看法、设计满足最终用户需求的培训以及调整培训和实施流程以支持有顾虑的护士的重要性。
