Holmgren A Jay, Pfeifer Eric, Manojlovich Milisa, Adler-Milstein Julia
A Jay Holmgren, 105 S State St, Ann Arbor, MI 48103, Email:
Appl Clin Inform. 2016 Dec 21;7(4):1182-1201. doi: 10.4338/ACI-2016-08-RA-0145.
As EHR adoption in US hospitals becomes ubiquitous, a wide range of IT options are theoretically available to facilitate physician-nurse communication, but we know little about the adoption rate of specific technologies or the impact of their use.
To measure adoption of hardware, software, and telephony relevant to nurse-physician communication in US hospitals. To assess the relationship between non-IT communication practices and hardware, software, and telephony adoption. To identify hospital characteristics associated with greater adoption of hardware, software, telephony, and non-IT communication practices.
We conducted a survey of 105 hospitals in the National Nursing Practice Network. The survey captured adoption of hardware, software, and telephony to support nurse-physician communication, along with non-IT communication practices. We calculated descriptive statistics and then created four indices, one for each category, by scoring degree of adoption of technologies or practices within each category. Next, we examined correlations between the three technology indices and the non-IT communication practices index. We used multivariate OLS regression to assess whether certain types of hospitals had higher index scores.
The majority of hospitals surveyed have a range of hardware, software, and telephony tools available to support nurse-physician communication; we found substantial heterogeneity across hospitals in non-IT communication practices. More intensive non-IT communication was associated with greater adoption of software (r=0.31, p=0.01), but was not correlated with hardware or telephony. Medium-sized hospitals had lower adoption of software (r =-1.14,p=0.04) in comparison to small hospitals, while federally-owned hospitals had lower software (r=-2.57, p=0.02) and hardware adoption (r=-1.63, p=0.01).
The positive relationship between non-IT communication and level of software adoption suggests that there is a complementary, rather than substitutive, relationship. Our results suggest that some technologies with the potential to further enhance communication, such as CPOE and secure messaging, are not being utilized to their full potential in many hospitals.
随着美国医院普遍采用电子健康记录（EHR），理论上有各种各样的信息技术选项可促进医生与护士之间的沟通，但我们对特定技术的采用率或其使用的影响了解甚少。
衡量美国医院中与医护沟通相关的硬件、软件和电话技术的采用情况。评估非信息技术沟通实践与硬件、软件和电话技术采用之间的关系。确定与更多采用硬件、软件、电话技术和非信息技术沟通实践相关的医院特征。
我们对国家护理实践网络中的105家医院进行了调查。该调查收集了用于支持医护沟通的硬件、软件和电话技术的采用情况，以及非信息技术沟通实践。我们计算了描述性统计数据，然后通过对每个类别中技术或实践的采用程度进行评分，为每个类别创建了四个指数。接下来，我们研究了三个技术指数与非信息技术沟通实践指数之间的相关性。我们使用多元OLS回归来评估某些类型的医院是否具有更高的指数得分。
大多数接受调查的医院都有一系列支持医护沟通的硬件、软件和电话工具；我们发现医院在非信息技术沟通实践方面存在很大差异。更多密集的非信息技术沟通与更高的软件采用率相关（r = 0.31，p = 0.01），但与硬件或电话技术无关。与小型医院相比，中型医院的软件采用率较低（r = -1.14，p = 0.04），而联邦政府所有的医院软件（r = -2.57，p = 0.02）和硬件采用率较低（r = -1.63，p = 0.01）。
非信息技术沟通与软件采用水平之间的正相关关系表明存在互补而非替代关系。我们的结果表明，一些有潜力进一步加强沟通的技术，如临床医嘱录入系统（CPOE）和安全消息传递，在许多医院中并未得到充分利用。
