Neri P M, Redden L, Poole S, Pozner C N, Horsky J, Raja A S, Poon E, Schiff G, Landman A
Clinical & Quality Analysis , Partners HealthCare System, Wellesley, MA.
Brigham and Women's Hospital , Boston, MA ; Neil and Elise Wallace STRATUS Center for Medical Simulation ; Simulation Consulting , Phoenix, Arizona, USA.
Appl Clin Inform. 2015 Jan 21;6(1):27-41. doi: 10.4338/ACI-2014-08-RA-0065. eCollection 2015.
To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules.
We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes.
Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources.
We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study.
了解急诊科（ED）医生对电子文档的使用情况，以便确定未来急诊科信息系统（EDIS）医生文档模块设计中的可用性和工作流程考量因素。
我们邀请急诊医学住院医师参与一项采用任务分析和定性访谈的混合方法研究。参与者在医学模拟中心完成一次模拟的标准化患者诊疗过程，同时在当前使用的EDIS测试环境中进行文档记录。我们记录了任务执行时间、参与者执行的任务类型和顺序（包括并行执行的任务）。然后，我们对每位参与者进行了半结构化访谈。我们使用持续比较法分析这些定性数据以生成主题。
八名住院医师参与了研究。模拟环节平均持续17分钟，参与者平均花费11分钟在包括电子文档记录在内的任务上。参与者并行执行任务，如病史采集和电子文档记录。8名参与者中有5名在环节的第一部分执行了相似的工作流程顺序，而其余三名使用了不同的工作流程。电子文档记录有三个主题特征：（1）医生报告文档记录的位置和时间根据患者病情严重程度和工作量而有所不同；（2）医生报告需要支持提高效率的功能；（3）医生喜欢查看可用的患者数据，但在将EDIS与其他信息源集成方面存在困难。
我们证实医生在急诊科患者就诊期间将大部分时间（65%）用于文档记录。此外，我们发现即使面对相同的标准化患者场景，住院医师并非都使用相同的工作流程和方法。未来电子健康记录（EHR）设计在试图优化效率时应考虑这些不同的工作流程，例如改善临床数据的集成。这些发现应在更大规模的代表性研究中进行定量测试。
