Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA.
Int J Med Inform. 2012 Aug;81(8):539-48. doi: 10.1016/j.ijmedinf.2012.02.010. Epub 2012 Mar 30.
Federal incentives to adopt interoperable, certified electronic health records (EHRs) with electronic prescribing (e-prescribing) are motivating providers using older EHRs to transition to newer EHRs. The objective of this study was to describe, from the perspective of experienced EHR users, the transition from an older, locally developed EHR with minimal clinical decision support (CDS) for e-prescribing to a newer, commercial EHR with more robust CDS for e-prescribing.
This qualitative, case study consisted of observations and semi-structured interviews of adult internal medicine faculty members (n=19) at an academic-affiliated ambulatory care clinic from January through November 2009. All providers transitioned from the older, locally developed EHR to the newer, commercial EHR in April 2008. We analyzed field notes of observations and transcripts of semi-structured interviews using qualitative methods guided by a grounded theory approach.
We identified key themes describing physician experiences. Despite intensive effort by the information systems team to ease the transition, even these experienced e-prescribers found transitioning extremely difficult. The commercial EHR was not perceived as improving medication safety, despite having more robust CDS. Additionally, physicians felt the commercial EHR was too complex, reducing their efficiency.
This is among the first studies examining physician experiences transitioning between an older, locally developed EHR to a newer, commercial EHR with more robust CDS for e-prescribing. Understanding physician experiences with this type of transition and their general preferences for prescribing applications may lead to less disruptive system implementations and better designed EHRs that are more readily accepted by providers. In this way, productivity and safety benefits may be maximized while mitigating potential threats associated with transitions.
ClinicalTrials.gov, Identifier: NCT00603070.
联邦政府激励采用具有电子处方（e-prescribing）功能的互操作、经过认证的电子健康记录（EHR），促使使用旧版 EHR 的医疗机构过渡到新版 EHR。本研究的目的是从经验丰富的 EHR 用户的角度描述从具有最小电子处方临床决策支持（CDS）功能的旧版、本地开发的 EHR 向具有更强大电子处方 CDS 功能的新版商业 EHR 的过渡。
这是一项定性的案例研究，包括对 2009 年 1 月至 11 月在学术附属门诊诊所的 19 名成年内科医生进行观察和半结构化访谈。所有医生都在 2008 年 4 月从旧版、本地开发的 EHR 过渡到新版商业 EHR。我们使用扎根理论方法指导的定性方法分析观察的现场记录和半结构化访谈的记录。
我们确定了描述医生经验的关键主题。尽管信息系统团队做出了巨大努力来缓解过渡，但即使是这些经验丰富的电子处方开具者也发现过渡非常困难。尽管新版商业 EHR 具有更强大的 CDS，但它并未被认为能提高药物安全性。此外，医生们认为商业 EHR 过于复杂，降低了他们的效率。
这是首批研究医生从旧版、本地开发的 EHR 过渡到新版、具有更强大电子处方 CDS 的商业 EHR 的经验的研究之一。了解医生在这种类型的过渡中的经验及其对处方应用程序的一般偏好，可能会导致系统实施的干扰更小，设计更完善的 EHR 更容易被医生接受。通过这种方式，可以最大限度地提高生产力和安全性效益，同时减轻与过渡相关的潜在威胁。
ClinicalTrials.gov，标识符：NCT00603070。
