Djalali Sima, Ursprung Nadine, Rosemann Thomas, Senn Oliver, Tandjung Ryan
Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
Int J Med Inform. 2015 Nov;84(11):920-32. doi: 10.1016/j.ijmedinf.2015.08.001. Epub 2015 Aug 4.
The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption.
We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows.
Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score.
A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger.
At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians.
全球范围内，健康信息技术（IT）的采用和使用持续增长。在瑞士，直至今日，政府和专业协会均未提供促进健康IT采用的激励措施。
我们旨在评估日常处理电子健康数据的医生比例，并描述医生与同行及其他医疗服务提供者交换电子健康数据的程度。此外，我们旨在估计医生对健康IT的态度对采用电子工作流程的影响。
2013年5月至7月期间，我们对瑞士1200名执业医生进行了横断面调查。受访者被要求报告他们处理实验室数据、检查结果、转诊信和医生信件的技术手段以及适用情况下的纸质替代方法。通过综合评分确定医生对健康IT使用的障碍和促进因素的看法。
回复率为57.1%（n = 685）。该样本被认为代表了瑞士门诊护理中的医生。35.2%的受访者借助在实践中一次或多次就诊生成的纵向半结构化电子文本记录记录患者的健康状况。根据工作流程中的任务不同，约11 - 46%的受访者表示依靠电子工作流程处理实验室和检查数据以及发送转诊单和医生信件。电子工作流程的长期使用并不常见。相反，受访者报告了影响工作流程中特定任务的纸质替代方法。医生对健康IT的态度与采用电子工作流程显著相关（OR 1.04 - 1.31，p < 0.05），但与工作环境相关的因素（如地区因素、医学专业、执业类型）的影响更大。
目前，瑞士门诊护理中只有少数医生日常处理电子健康数据。在更多同行参与结构化临床信息的电子交换之前，大多数医生将继续使用纸质系统和替代方法。调查发现，对健康IT持积极态度的医生更有可能采用电子工作流程，但影响较小。可能有必要引入经济激励措施并制定国家标准，以促进大量执业临床医生的采用。
