Ancker Jessica S, Kern Lisa M, Edwards Alison, Nosal Sarah, Stein Daniel M, Hauser Diane, Kaushal Rainu
Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA Health Information Technology Evaluation Collaborative (HITEC), New York, USA.
Institute for Family Health, New York, USA.
J Am Med Inform Assoc. 2014 Nov-Dec;21(6):1001-8. doi: 10.1136/amiajnl-2013-002627. Epub 2014 Jun 9.
Studies of the effects of electronic health records (EHRs) have had mixed findings, which may be attributable to unmeasured confounders such as individual variability in use of EHR features.
To capture physician-level variations in use of EHR features, associations with other predictors, and usage intensity over time.
Retrospective cohort study of primary care providers eligible for meaningful use at a network of federally qualified health centers, using commercial EHR data from January 2010 through June 2013, a period during which the organization was preparing for and in the early stages of meaningful use.
Data were analyzed for 112 physicians and nurse practitioners, consisting of 430,803 encounters with 99,649 patients. EHR usage metrics were developed to capture how providers accessed and added to patient data (eg, problem list updates), used clinical decision support (eg, responses to alerts), communicated (eg, printing after-visit summaries), and used panel management options (eg, viewed panel reports). Provider-level variability was high: for example, the annual average proportion of encounters with problem lists updated ranged from 5% to 60% per provider. Some metrics were associated with provider, patient, or encounter characteristics. For example, problem list updates were more likely for new patients than established ones, and alert acceptance was negatively correlated with alert frequency.
Providers using the same EHR developed personalized patterns of use of EHR features. We conclude that physician-level usage of EHR features may be a valuable additional predictor in research on the effects of EHRs on healthcare quality and costs.
关于电子健康记录（EHRs）影响的研究结果不一，这可能归因于未测量的混杂因素，如EHR功能使用中的个体差异。
了解医生层面在EHR功能使用上的差异、与其他预测因素的关联以及随时间的使用强度。
对符合在联邦合格健康中心网络中实现有意义使用条件的初级保健提供者进行回顾性队列研究，使用2010年1月至2013年6月的商业EHR数据，在此期间该组织正为有意义使用做准备并处于早期阶段。
对112名医生和执业护士的数据进行了分析，包括与99,649名患者的430,803次诊疗。开发了EHR使用指标来记录提供者如何访问和添加患者数据（如问题列表更新）、使用临床决策支持（如对警报的响应）、沟通（如打印就诊后总结）以及使用面板管理选项（如查看面板报告）。提供者层面的差异很大：例如，每位提供者更新问题列表的诊疗的年平均比例在5%至60%之间。一些指标与提供者、患者或诊疗特征相关。例如，新患者比老患者更有可能更新问题列表，警报接受率与警报频率呈负相关。
使用相同EHR的提供者形成了个性化的EHR功能使用模式。我们得出结论，医生层面的EHR功能使用可能是研究EHRs对医疗质量和成本影响的一个有价值的额外预测因素。
