Belletti Dan, Zacker Christopher, Mullins C Daniel
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA;
Patient Relat Outcome Meas. 2010 Jul;1:29-37. doi: 10.2147/prom.s8896. Epub 2010 Apr 30.
Health information technology (HIT) is engineered to promote improved quality and efficiency of care, and reduce medical errors. Healthcare organizations have made significant investments in HIT tools and the electronic medical record (EMR) is a major technological advance. The Department of Veterans Affairs was one of the first large healthcare systems to fully implement EMR. The Veterans Health Information System and Technology Architecture (VistA) began by providing an interface to review and update a patient's medical record with its computerized patient record system. However, since the implementation of the VistA system there has not been an overall substantial adoption of EMR in the ambulatory or inpatient setting. In fact, only 23.9% of physicians were using EMRs in their office-based practices in 2005. A sample from the American Medical Association revealed that EMRs were available in an office setting to 17% of physicians in late 2007 and early 2008. Of these, 17% of physicians with EMR, only 4% were considered to be fully functional EMR systems. With the exception of some large aggregate EMR databases the slow adoption of EMR has limited its use in outcomes research. This paper reviews the literature and presents the current status of and forces influencing the adoption of EMR in the office-based practice, and identifies the benefits, limitations, and overall value of EMR in the conduct of outcomes research in the US.
健康信息技术（HIT）旨在提高医疗质量和效率，并减少医疗差错。医疗保健机构已在HIT工具方面投入了大量资金，而电子病历（EMR）是一项重大的技术进步。退伍军人事务部是最早全面实施EMR的大型医疗系统之一。退伍军人健康信息系统与技术架构（VistA）最初通过其计算机化患者记录系统提供了一个用于查看和更新患者病历的界面。然而，自VistA系统实施以来，门诊或住院环境中EMR的整体采用率并不高。事实上，2005年只有23.9%的医生在其门诊实践中使用EMR。美国医学协会的一个样本显示，在2007年末和2008年初，17%的医生在门诊环境中可以使用EMR。其中，拥有EMR的医生中，只有4%的被认为是功能齐全的EMR系统。除了一些大型综合EMR数据库外，EMR采用率低限制了其在结果研究中的应用。本文回顾了相关文献，介绍了门诊实践中EMR采用的现状和影响因素，并确定了EMR在美国进行结果研究中的益处、局限性和总体价值。
