Division of General Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
BMC Med Inform Decis Mak. 2013 Aug 9;13:86. doi: 10.1186/1472-6947-13-86.
Despite considerable financial incentives for adoption, there is little evidence available about providers' use and satisfaction with key functions of electronic health records (EHRs) that meet "meaningful use" criteria.
We surveyed primary care providers (PCPs) in 11 general internal medicine and family medicine practices affiliated with 3 health systems in Texas about their use and satisfaction with performing common tasks (documentation, medication prescribing, preventive services, problem list) in the Epic EHR, a common commercial system. Most practices had greater than 5 years of experience with the Epic EHR. We used multivariate logistic regression to model predictors of being a structured documenter, defined as using electronic templates or prepopulated dot phrases to document at least two of the three note sections (history, physical, assessment and plan).
146 PCPs responded (70%). The majority used free text to document the history (51%) and assessment and plan (54%) and electronic templates to document the physical exam (57%). Half of PCPs were structured documenters (55%) with family medicine specialty (adjusted OR 3.3, 95% CI, 1.4-7.8) and years since graduation (nonlinear relationship with youngest and oldest having lowest probabilities) being significant predictors. Nearly half (43%) reported spending at least one extra hour beyond each scheduled half-day clinic completing EHR documentation. Three-quarters were satisfied with documenting completion of pneumococcal vaccinations and half were satisfied with documenting cancer screening (57% for breast, 45% for colorectal, and 46% for cervical). Fewer were satisfied with reminders for overdue pneumococcal vaccination (48%) and cancer screening (38% for breast, 37% for colorectal, and 31% for cervical). While most believed the problem list was helpful (70%) and kept an up-to-date list for their patients (68%), half thought they were unreliable and inaccurate (51%).
Dissatisfaction with and suboptimal use of key functions of the EHR may mitigate the potential for EHR use to improve preventive health and chronic disease management. Future work should optimize use of key functions and improve providers' time efficiency.
尽管有相当大的经济激励措施来促进收养，但关于符合“有意义使用”标准的电子健康记录 (EHR) 的关键功能的使用情况和提供者满意度，几乎没有可用的证据。
我们调查了德克萨斯州 3 个医疗系统下属的 11 个综合内科和家庭医学实践中的初级保健提供者 (PCP)，了解他们在使用 Epic EHR 执行常见任务（文档记录、药物处方、预防服务、问题清单）方面的使用情况和满意度，Epic EHR 是一种常见的商业系统。大多数实践都有超过 5 年的 Epic EHR 使用经验。我们使用多变量逻辑回归模型来预测成为结构化文档记录者的可能性，结构化文档记录者的定义是使用电子模板或预填充点短语记录至少三个注释部分（病史、体检、评估和计划）中的两个部分。
146 名 PCP 做出了回应（70%）。大多数人使用自由文本记录病史（51%）和评估和计划（54%），并使用电子模板记录体检（57%）。一半的 PCP 是结构化文档记录者（55%），其中家庭医学专业（调整后的 OR 3.3，95%CI，1.4-7.8）和毕业后的年限（与最年轻和最年长的年限呈非线性关系，概率最低）是显著的预测因素。近一半（43%）的人报告说，他们每完成一次预定的半天诊所，都要花至少一个小时以上的时间来完成 EHR 文档记录。四分之三的人对记录肺炎球菌疫苗接种完成情况感到满意，一半的人对记录癌症筛查情况感到满意（乳腺癌为 57%，结直肠癌为 45%，宫颈癌为 46%）。对肺炎球菌疫苗接种过期提醒的满意度较低（48%）和癌症筛查（乳腺癌为 38%，结直肠癌为 37%，宫颈癌为 31%）。虽然大多数人认为问题清单很有帮助（70%），并为患者保持最新的清单（68%），但有一半的人认为它们不可靠和不准确（51%）。
对 EHR 关键功能的不满和使用不佳，可能会降低 EHR 在改善预防保健和慢性病管理方面的潜在作用。未来的工作应该优化关键功能的使用，并提高提供者的时间效率。
