University of Central Florida, Orlando, FL, USA.
J Med Syst. 2013 Aug;37(4):9955. doi: 10.1007/s10916-013-9955-2. Epub 2013 Jun 19.
Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.
在《健康信息技术促进经济和临床健康法案》（HITECH）的推动下，大量医生和医院现在正在实施电子健康记录（EHR），普遍期望这些系统将提高医疗服务的质量、安全性和效率。从纸质记录转换为电子记录的研究描绘了一幅喜忧参半的画面，医疗服务提供者对他们的 EHR 的某些方面感到满意，但对其他方面不满意。这些先前的研究侧重于从纸质记录转换为电子记录。因此，许多提供者的印象可能受到对必须改变既定模式的过程的反应的影响。为了帮助将这种反应与 EHR 的功效的真实评估分开，我们决定在一个新的医疗中心调查提供者。为了确保收集的信息不仅仅是轶事，我们使用了一种经过充分验证的格式，从半结构化访谈开始，这有助于分析和识别主要主题。我们围绕几个重要领域包括工作流程、沟通、患者满意度、生产力、文件记录和护理质量提出了问题。出现了十个主要主题：阻碍患者流动、阻碍办公室内沟通、改善就诊后的沟通、改善患者护理跟踪、与患者相处的时间减少、需要更多培训、希望有更多功能、生产力降低、欣赏模板的好处以及增强内部沟通。需要更好的培训似乎尤为重要，因为它影响了其他几个主题。我们相信，我们的研究有助于验证从纸质记录系统过渡研究中表达的类似担忧。我们的方法可能对其他诊所普遍有用，因为它有助于及时识别临床医生和诊所经理希望在早期阶段了解的积极和消极主题。及时了解这些正在发展的主题可能有助于突出 EHR 的积极方面，并防止消极主题发展成为可能被认为是 EHR 使用的严重意外后果的严重问题。
