Psychiatr Serv. 2013 Oct;64(10):946-9. doi: 10.1176/appi.ps.201300272.
This column describes the potential of an enhanced electronic medical record (EMR) to advance best practices by displaying patient history, measuring progress, and facilitating clinical research. To create a graphical, single-page display of patient history, the authors examined data in the Minneapolis Department of Veterans Affairs EMR system, including 1.8 million encounters for 50,000 mental health patients. The prototype dashboard presents information on a patient's current and past providers, diagnoses, therapeutic interventions, prescriptions, dosages, and outcomes. To provide needed outcome data to monitor patient progress, the authors tested two questions with 212 patients. Patient and clinician responses to the questions provide reliable and clinically useful data that can be used in the EMR to track patient change over time. Use of EMRs can bridge gaps between science and practice to inform diagnosis and treatment decisions and permit more accurate prognoses.
本专栏描述了增强型电子病历(EMR)通过显示患者病史、衡量进展和促进临床研究来推进最佳实践的潜力。为了创建患者病史的图形化单页显示,作者检查了明尼苏达州退伍军人事务部 EMR 系统中的数据,其中包括 5 万名精神健康患者的 180 万次就诊。该原型仪表板展示了患者当前和过去的提供者、诊断、治疗干预、处方、剂量和结果的信息。为了提供监测患者进展所需的结果数据,作者用 212 名患者测试了两个问题。患者和临床医生对这些问题的回答提供了可靠且具有临床意义的数据,这些数据可用于 EMR 中,以跟踪患者随时间的变化。EMR 的使用可以弥合科学与实践之间的差距,为诊断和治疗决策提供信息,并允许更准确的预后。