Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, United Kingdom.
Int J Med Inform. 2012 Jan;81(1):45-52. doi: 10.1016/j.ijmedinf.2011.09.002. Epub 2011 Oct 1.
There are few opportunities to study the use of integrated electronic health record (EHR) systems, where single patient records are used by a number of health care staff. The purpose of the study was to understand how an integrated electronic health record system was used by health care staff in the treatment and management of diabetes patients. The investigation was focused on the interface between the primary and secondary care services which patients access for their diabetes care.
Observations of the use of an integrated electronic health record during patients' consultations with health care staff were conducted over a three month period. Twelve patients were followed through their consultations with a range of health care staff at a secondary care Diabetes Centre and in primary care settings. A thematic analysis of the observation data was undertaken.
The integrated electronic health record system had been implemented across the primary and secondary care interface and was used by many, but not all, clinicians involved in the care of patients with diabetes. In some areas of care it enabled health care staff to access more accurate and detailed information to inform their clinical decision-making. Issues including negotiating rules for accessing patient records and duplication of recording in paper record systems had not been resolved consistently across services.
The findings offer suggestive evidence that a shared electronic health record can support more integrated care. Unresolved issues in implementing the system across all services and settings highlight the governance problems that can arise when systems are developed locally but are then extended across organisational and professional boundaries.
很少有机会研究集成电子健康记录（EHR）系统的使用情况，在这种系统中，许多医疗保健人员会使用单个患者的记录。本研究的目的是了解医疗保健人员如何在治疗和管理糖尿病患者时使用集成电子健康记录系统。调查的重点是患者接受糖尿病护理的初级和二级保健服务之间的接口。
在三个月的时间里，对医疗保健人员在患者咨询期间使用集成电子健康记录的情况进行了观察。对十二名患者在二级糖尿病中心和初级保健环境中与一系列医疗保健人员的咨询情况进行了随访。对观察数据进行了主题分析。
该集成电子健康记录系统已在初级和二级保健界面上实施，并被参与糖尿病患者护理的许多（但不是全部）临床医生使用。在某些护理领域，它使医疗保健人员能够获取更准确、更详细的信息，为他们的临床决策提供依据。在服务之间，一些问题，如协商访问患者记录的规则以及在纸质记录系统中重复记录，尚未得到一致解决。
研究结果提供了一些有说服力的证据，表明共享电子健康记录可以支持更具整合性的护理。在整个服务和环境中实施系统方面存在的未解决问题突显了当系统在本地开发但随后扩展到组织和专业边界时可能出现的治理问题。
