Assessment of Technology in Context Design Lab, School of Communication, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.
Int J Med Inform. 2012 Jul;81(7):461-74. doi: 10.1016/j.ijmedinf.2012.01.003. Epub 2012 Jan 29.
It is argued that with the introduction of electronic medical record (EMR) systems into the primary care sector, data collected can be used for secondary purposes which extend beyond individual patient care (e.g., for chronic disease management, prevention and clinical performance evaluation). However, EMR systems are primarily designed to support clinical tasks, and data entry practices of clinicians focus on the treatment of individual patients. Hence data collected through EMRs is not always useful in meeting these ends.
In this paper we follow a community health centre (CHC), and document the changes in work practices of the personnel that were necessary in order to make EMR data useful for secondary purposes.
This project followed an action research approach, in which ethnographic data were collected mainly by participant observations, by a researcher who also acted as an IT support person for the clinic's secondary usage of EMR data. Additionally, interviews were carried out with the clinical and administrative personnel of the CHC.
The case study demonstrates that meaningful use of secondary data occurs only after a long process, aimed at creating the pre-conditions for meaningful use of secondary data, has taken place. PRECONDITIONS: Specific areas of focus have to be chosen for secondary data use, and initiatives have to be continuously evaluated and adapted to the workflow through a team approach. Collaboration between IT support and physicians is necessary to tailor the software to allow for the collection of clinically relevant data. Data entry procedures may have to be changed to encourage the usage of an agreed-upon coding scheme, required for meaningful use of secondary data. And finally resources in terms of additional personnel or dedicated time are necessary to keep up with data collection and other tasks required as a pre-condition to secondary use of data, communication of the results to the clinic, and eventual re-evaluation.
Changes in the work practices observed in this case which were required to support secondary data use from the EMR included completion of additional tasks by clinical and administrative personnel related to the organization of follow-up tasks. Among physicians increased awareness of specific initiatives and guideline compliance in terms of chronic disease management and prevention was noticed. Finally, the clinic was able to evaluate their own practice and present the results to varied stakeholders.
The case describes the secondary usage of data by a clinic aimed at improving management of the clinic's patients. It illustrates that creating the pre-conditions for secondary use of data from EMRs is a complex process which can be seen as a shift in paradigms from a focus on individual patient care to chronic disease management and performance measurement. More research is needed about how to best support clinics in the process of change management necessitated by emerging clinical management goals.
有人认为，随着电子病历 (EMR) 系统引入基层医疗领域，所收集的数据可用于超出个体患者护理范围的其他目的（例如，用于慢性病管理、预防和临床绩效评估）。然而，EMR 系统主要用于支持临床任务，临床医生的数据录入实践侧重于治疗个体患者。因此，通过 EMR 收集的数据并不总是能满足这些目的。
在本文中，我们跟踪了一个社区卫生中心 (CHC)，记录了为使 EMR 数据可用于其他目的而必须改变人员工作实践的情况。
本项目采用行动研究方法，主要通过参与观察收集民族志数据，研究人员还担任诊所 EMR 数据二次使用的 IT 支持人员。此外，还对 CHC 的临床和行政人员进行了访谈。
案例研究表明，只有在经过一个长期的过程之后，才能实现有意义地使用二次数据，该过程旨在为有意义地使用二次数据创造前提条件。前提条件：必须选择特定的重点领域用于二次数据使用，并通过团队方法不断评估和调整举措，使其适应工作流程。IT 支持人员和医生之间的协作对于根据临床相关数据定制软件是必要的。数据录入程序可能需要更改，以鼓励使用有意义地使用二次数据所需的商定编码方案。最后，需要额外的人员或专用时间方面的资源来跟上数据收集和其他作为二次使用数据的前提条件的任务、将结果传达给诊所，以及最终重新评估。
为支持从 EMR 中使用二次数据，观察到案例中观察到的工作实践发生的变化包括临床和行政人员完成与后续任务组织相关的额外任务。在医生中，注意到对慢性病管理和预防方面特定举措和指南合规性的认识有所提高。最后，该诊所能够评估自己的实践并向各种利益相关者展示结果。
该案例描述了一家诊所对 EMR 数据的二次使用，旨在改善对诊所患者的管理。它说明了为 EMR 数据的二次使用创造前提条件是一个复杂的过程，可以看作是从关注个体患者护理到慢性病管理和绩效测量的范式转变。需要进一步研究如何最好地支持诊所应对新兴临床管理目标所必需的变革管理过程。
