Lambooij Mattijs S, Drewes Hanneke W, Koster Ferry
Department Quality of care and health Economics, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
Department Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
BMC Med Inform Decis Mak. 2017 Feb 10;17(1):17. doi: 10.1186/s12911-017-0412-x.
As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs.
Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data.
Doctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine.
The result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.
由于医院实施电子病历（EMR）可能会受到不同用户群体不同反应的挑战，本文研究了医生和护士在其医院对电子病历实施和使用的反应差异，以及这如何影响电子病历中数据的感知质量。
采用多组结构方程模型（SEM）分析了402名有医院电子病历实施和使用经验的医生和512名护士的问卷数据。模型包括组织因素的测量、实施结果（易用性和电子病历与日常工作的契合度）、感知附加值、使用及时性和患者数据的感知质量。
在考虑实施成功的情况下，医生和护士对组织因素（信息技术、人力资源和行政部门的支持）的反应存在差异。护士对文化有反应，而医生则没有。医生和护士一致认为，更易于使用且与工作更契合的电子病历具有更多附加值，但对医生来说这种情况更明显。医生和护士认为，当电子病历更易于使用且与日常工作更契合时，患者数据的质量更好。
就易用性和与工作的契合度而言，实施结果似乎比输入患者数据的及时性更强烈地影响患者数据的感知质量。医生和护士重视自下而上的沟通以及信息技术部门对实施结果的支持，并且护士对开放和创新的组织文化有反应。
