Innovation, Health Outcomes and Pharmaceutical Economics, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267-0004, USA.
J Am Med Inform Assoc. 2013 Mar-Apr;20(2):268-76. doi: 10.1136/amiajnl-2012-001099. Epub 2012 Oct 9.
To observe the effect of electronic medical record (EMR) system sophistication on preventive women's healthcare.
Providers in the National Ambulatory Medical Care Survey (NAMCS), 2007-8, were included if they had at least one visit by a woman at least 21 years old. Based on 16 questions from NAMCS, the level of a provider's EMR system sophistication was classified as non-existent, minimal, basic, or fully functional. A two-stage residual-inclusion method was used with ordered probit regression to model the level of EMR system sophistication, and outcome-specific Poisson regressions to predict the number of examinations or tests ordered or performed.
Across the providers, 29.23%, 49.34%, 15.97%, and 5.46% had no, minimal, basic, and fully functional EMR systems, respectively. The breast examination rate was 20.27%, 34.96%, 37.21%, and 44.98% for providers without or with minimal, basic, and fully functional EMR systems, respectively. For breast examinations, pelvic examinations, Pap tests, chlamydia tests, cholesterol tests, mammograms, and bone mineral density (BMD) tests, an EMR system increased the number of these tests and examinations. Furthermore, the level of sophistication increased the number of breast examinations and Pap, chlamydia, cholesterol, and BMD tests.
The use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women's health should consider investing in more sophisticated systems.
The presence of an EMR system has a positive impact on preventive women's healthcare; the more functions that the system has, the greater the number of examinations and tests given or prescribed.
观察电子病历(EMR)系统的复杂程度对女性预防保健的影响。
纳入 2007-8 年全国门诊医疗调查(NAMCS)中至少有一名 21 岁以上女性就诊的提供者。根据 NAMCS 的 16 个问题,将提供者的 EMR 系统复杂程度分为不存在、最低限度、基本和完全功能。采用两阶段剩余纳入法,采用有序概率回归对 EMR 系统复杂程度进行建模,采用特定于结果的泊松回归预测所订购或执行的检查或测试数量。
在所有提供者中,分别有 29.23%、49.34%、15.97%和 5.46%没有、最低限度、基本和完全功能的 EMR 系统。没有或最低限度、基本和完全功能 EMR 系统的提供者的乳房检查率分别为 20.27%、34.96%、37.21%和 44.98%。对于乳房检查、盆腔检查、巴氏检查、衣原体检查、胆固醇检查、乳房 X 光检查和骨密度(BMD)检查,EMR 系统增加了这些检查和检查的数量。此外,复杂程度的提高增加了乳房检查、巴氏检查、衣原体、胆固醇和 BMD 检查的数量。
妇产科中使用先进的 EMR 系统的情况有限。鉴于本研究的积极结果,妇女健康专家应考虑投资更复杂的系统。
EMR 系统的存在对女性预防保健有积极影响;系统具有的功能越多,所进行或规定的检查和测试的数量就越多。