安全消息传递对初级保健工作流程的影响：一项多案例、多方法研究的结果。
The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study.
作者信息
Hoonakker Peter L T, Carayon Pascale, Cartmill Randi S
机构信息
Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA.
Center for Quality and Productivity Improvement (CQPI), University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
出版信息
Int J Med Inform. 2017 Apr;100:63-76. doi: 10.1016/j.ijmedinf.2017.01.004. Epub 2017 Jan 18.
INTRODUCTION
Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients.
METHODS
We used a multiple case study design with multiple data collections methods (observation, interviews and survey).
RESULTS
Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety.
CONCLUSION
Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used.
引言
安全消息传递是健康信息技术（IT）中一项相对较新的功能。多项研究探讨了安全消息传递对（临床）结果的影响，但很少有研究考察其对基层医疗诊所工作流程的影响。在本研究中，我们考察了安全消息传递对临床医生、工作人员和患者工作流程的影响。
方法
我们采用多案例研究设计，并运用多种数据收集方法（观察、访谈和调查）。
结果
结果表明，安全消息传递有潜力改善基层医疗诊所的沟通、信息流及工作组织，部分原因是其支持异步通信。然而，安全消息传递也可能对沟通产生负面影响并增加工作量，特别是当患者发送的消息不适合通过安全消息传递媒介发送时（例如，消息过长、复杂、模糊或不合适）。结果显示，临床医生对安全消息传递持矛盾态度。安全消息传递会增加他们的工作量，尤其是在消息量很大时，而且目前他们并未因这些工作获得补偿。工作人员——尤其是与临床医生相比——对安全消息传递相对积极，患者总体上对安全消息传递非常满意。最后，临床医生、工作人员和患者认为安全消息传递可对医疗质量和患者安全产生积极影响。
结论
安全消息传递是一种有潜力改善沟通和信息流的工具。然而，安全消息传递改善工作流程的潜力取决于其实施和使用方式。
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