Craven Catherine K, Sievert MaryEllen C, Hicks Lanis L, Alexander Gregory L, Hearne Leonard B, Holmes John H
MU Informatics Institute, University of Missouri, Columbia, MO, USA.
Stud Health Technol Inform. 2013;192:608-12.
The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.
美国政府已拨款300亿美元，通过一项名为“有意义使用”的政策，在医院和医疗服务机构推行电子健康记录（EHRs）。小型农村医院，尤其是那些被指定为临界接入医院（CAHs）的机构，占美国医院总数近四分之一，此前尚未实施电子健康记录。对于这种情况下的实施情况，人们了解甚少。我们采访了该领域的31位专家。随后对访谈进行了定性分析，以确定专家的建议。共出现了19个主题。专家群体包括最近实施了电子健康记录的临界接入医院的工作人员。我们能够将他们的答案与其他专家的答案进行比较，并为利益相关者提出建议。临界接入医院的同行专家较少关注诸如医生接受度、沟通和电子健康记录团队等问题。他们中没有人表示对临床决策支持系统、领导力或治理方面的关注。他们特别关注系统选择、技术、准备工作以及需要更多了解工作流程和优化。这些差异是由这些小型医院的规模和性质所解释的。
