Riahi Sanaz, Fischler Ilan, Stuckey Melanie I, Klassen Philip E, Chen John
Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
JMIR Med Inform. 2017 Jan 5;5(1):e1. doi: 10.2196/medinform.6512.
Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking.
The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization.
The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence.
Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings.
EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels.
许多机构已采用电子病历（EMR）来提高医疗质量。但目前仍缺乏支持其为以康复为导向的精神卫生机构带来附加价值的证据。
本项目的目标是在一家专门的、以康复为导向的精神卫生保健机构中实施并定制一个完全集成的电子病历系统。本评估检查了由电子病历推动的质量改进举措的成果，以确定电子病历给该机构带来的价值。
研究地点为加拿大安大略省的一家三级精神卫生机构。临床信息学和决策支持部门与床边护理人员密切合作，在电子病历中开发工作流程和文档工具。主要举措包括实施闭环用药管理模块、协作护理计划、精神分裂症临床实践指南、尽量减少约束、感染预防与控制监测状态板、药物滥用筛查以及商业智能。
自2014年4月以来，用药和患者扫描率一直高于95%，减轻了用药错误的不良影响。具体而言，在2014年4月至2015年3月期间，仅发生了1起中度严重和0起严重药物不良事件。约束事件的数量减少了19.7%，在两年内节省了超过140万加元（100万美元）的成本。精神分裂症临床实践指南的实施提高了对循证实践的依从性，使整个机构的护理标准化。改进的感染预防与控制监测将暴发天数从状态板实施前一年的47天减少到实施后一年的7天。在临床指征明确时，鼓励优先使用具有成本效益的药物滥用筛查的决策支持措施为机构节省了成本。
电子病历的实施使安大略省湖滨精神卫生科学中心能够利用数据分析来识别和选择合适的质量改进举措，支持以患者为中心、以康复为导向的实践，并在临床、机构和社会层面提供价值。
