Elias Beth, Barginere Marlena, Berry Phillip A, Selleck Cynthia S
a School of Nursing, Community Health, Outcomes and Systems, University of Alabama at Birmingham , Birmingham , AL , USA .
b Department of Medical Nursing , University of Alabama at Birmingham , Birmingham , AL , USA .
J Interprof Care. 2015;29(6):551-4. doi: 10.3109/13561820.2015.1021001. Epub 2015 May 8.
Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.
即使在行政和临床角色与职责明确界定的传统医疗环境中，实施电子健康记录（EHR）系统也具有挑战性。然而，即便在这些传统环境中，利益相关者相互冲突的需求也可能引发层级决策过程，这反映了当今医疗保健领域的传统权力结构。这些传统流程并非为纳入新的患者护理模式（如以患者为中心的护理和跨专业团队）而设计。随着医疗保健转向以患者为中心的模式，在短期和长期临床决策中纳入患者、家庭、多个机构和跨专业团队，将需要新的EHR实施和评估流程。这种新模式将由医疗信息技术推动，并由信息流、工作流程和沟通需求来界定。我们描述了一个正在开发的模型，用于在跨专业、跨机构的免费诊所环境中配置和实施EHR系统。该模型使用基于可用性的形成性评估过程来配置EHR，以充分支持作为跨专业团队工作的各类提供者的需求。要使该模型成功，必须将信息专家作为医疗团队平等且重要的成员纳入其中。
