Wylie Matthew C, Baier Rosa R, Gardner Rebekah L
Brown University School of Public Health, Providence, RI.
Brown University School of Public Health, Providence, RI; Healthcentric Advisors, Providence, RI.
Am J Med. 2014 Oct;127(10):1010.e21-7. doi: 10.1016/j.amjmed.2014.06.011. Epub 2014 Jun 16.
Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience.
We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice.
The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction.
We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time.
尽管电子健康记录的使用改善了医疗服务的提供，但在临床实践中的采用情况并不完整。我们试图确定罗德岛州的采用程度以及与积极体验相关的医生和电子健康记录的特征。
我们对罗德岛州卫生部在2009年至2013年期间收集的健康信息技术调查数据进行了横断面研究。调查问题包括提供者和医疗机构的人口统计学特征、健康记录信息以及关于电子健康记录使用如何影响临床实践的李克特量表式问题。
调查回复率在50%至65%之间，2013年为62%。罗德岛州使用电子健康记录的医生数量不断增加。2013年，81%的医生使用了电子健康记录，且采用情况因临床亚专业而异。大多数提供者认为电子健康记录的使用改善了计费和质量改进，但并未提高工作满意度。使用电子健康记录时间更长、更复杂的医生报告称，引入电子健康记录对所考察的实践的各个方面都产生了积极影响(P <.001)。医生年龄较大与对引入电子健康记录的评价较差相关(P <.001)。在罗德岛州最常使用的18家电子健康记录供应商中，有5家与提高工作满意度相关。
我们报告了迄今为止最大规模的全州范围电子健康记录采用情况研究。我们发现罗德岛州医生的使用量在增加，采用程度因亚专业而异。尽管老年医生对采用电子健康记录的积极性较低，但使用时间更长、更复杂与更积极的看法相关，这表明随着时间的推移，接受度将会提高。
