Tanner C, Gans D, White J, Nath R, Pohl J
Michigan Public Health Institute , Okemos, Michigan, United States.
Medical Group Management Association , Englewood, Colorado, United States.
Appl Clin Inform. 2015 Mar 11;6(1):136-47. doi: 10.4338/ACI-2014-11-RA-0099. eCollection 2015.
The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated.
This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program.
We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication.
Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association.
Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.
电子健康记录（EHR）在提高患者安全方面的作用，虽在许多研究中得到证实，但仍存在争议。
本文研究初级保健中早期采用电子健康记录的情况，以了解与使用纸质记录的医疗机构相比，电子健康记录的实施在多大程度上与促进患者安全的工作流程、政策和实践相关。早期采用者定义为在“有意义使用”计划实施之前就使用电子健康记录的机构。
我们利用医生执业患者安全评估（PPPSA）来比较完全实施电子健康记录的初级保健机构与使用纸质记录的机构。PPPSA衡量在药物管理、交接与转诊、人员资质与能力、执业管理与文化以及患者沟通等领域采用患者安全实践的程度。
分析纳入了2006年至2010年间回复的209家初级保健机构的数据：117家机构使用纸质病历，92家使用电子健康记录。结果显示，在所有领域中，使用电子健康记录的机构在促进患者安全的工作流程、政策和实践方面的比例显著高于使用纸质记录的机构。虽然在药物管理领域这些结果在意料之中，但电子健康记录的使用还与研究人员事先未预期到有相关性的领域中采用患者安全实践有关。
电子健康记录使用的社会技术模型指出了技术与环境中其他方面（与人力资源、工作流程、政策、文化等相关）之间的复杂相互作用。本研究表明，在国家PPPSA数据库中的初级保健机构中，从经验上看，拥有电子健康记录与门诊环境中安全患者护理所推荐的工作流程、政策、沟通和文化实践密切相关。
