Marmor Rebecca A, Clay Brian, Millen Marlene, Savides Thomas J, Longhurst Christopher A
Appl Clin Inform. 2018 Jan;9(1):11-14. doi: 10.1055/s-0037-1620263. Epub 2018 Jan 3.
The increased emphasis on patient satisfaction has coincided with the growing adoption of electronic health records (EHRs) throughout the U.S. The 2001 Institute of Medicine Report, “Crossing the Quality Chasm,” identified patient-centered care as a key element of quality health care.[1] In response to this call, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed to assess patients' health care experiences in the inpatient setting. Simultaneously, financial incentives have facilitated the rapid adoption of EHR applications, with 84% of hospitals maintaining at least a basic EHR in 2015 (a ninefold increase since 2008).[2]
Despite the concurrent deployment of patient satisfaction surveys and EHRs, there is a poor understanding of the relationship that may exist between physician usage of the EHR and patient satisfaction. Most prior research into the impact of the EHR on physician–patient communication has been observational, describing the behaviors of physicians and patients when the clinician accesses an EHR in the exam room. Past research has shown that encounters where physicians access the EHR are often filled with long pauses,[3] and that few clinicians attempt to engage patients by sharing what they are looking at on the screen.[4] A recent meta-analysis reviewing 53 papers found that only 7 studies attempted to correlate objective observations of physician communication behaviors with patient perceptions by eliciting feedback from the patients.[5] No study used a standardized assessment tool of patient satisfaction. The authors conclude that additional work is necessary to better understand the patient perspective of the presence of an EHR during a clinical encounter.
Additionally, increasing EHR adoption and emphasis on patient satisfaction have also corresponded with rising physician burnout rates.[6] [7] Prior work suggests that EHR adoption may be contributing to this trend.[8] Burnout from the EHR may be due in part to the significant amount of time physicians spend logged into systems, documenting long after clinic has ended in effort to avoid disrupting the patient–physician relationship.[9]
We used existing data sources to describe the relationship between the amount of time physicians spend logged in to the EHR—both during daytime hours as well after clinic hours—and performance on a validated patient satisfaction survey. Our null hypothesis is that there is no relationship between increased time logged in to the EHR and patient satisfaction.
对患者满意度的日益重视与美国电子健康记录（EHR）的广泛采用同时出现。2001年医学研究所的报告《跨越质量鸿沟》将以患者为中心的护理确定为优质医疗保健的关键要素。[1] 作为对此呼吁的回应，开发了医院医疗服务提供者和系统消费者评估（HCAHPS）调查，以评估患者在住院环境中的医疗体验。同时，经济激励措施促进了EHR应用的迅速采用，2015年84%的医院至少拥有基本的EHR（自2008年以来增长了九倍）。[2]
尽管同时开展了患者满意度调查和EHR，但对于EHR的医生使用情况与患者满意度之间可能存在何种关系，人们了解甚少。之前关于EHR对医患沟通影响的大多数研究都是观察性的，描述了临床医生在检查室访问EHR时医生和患者的行为。过去的研究表明，医生访问EHR的诊疗过程中常常有长时间的停顿，[3] 而且很少有临床医生试图通过分享他们在屏幕上看到的内容来与患者互动。[4] 最近一项对５３篇论文的荟萃分析发现，只有７项研究试图通过征求患者反馈来将医生沟通行为的客观观察与患者认知联系起来。[5] 没有研究使用标准化的患者满意度评估工具。作者得出结论，需要开展更多工作，以更好地了解临床诊疗过程中患者对EHR存在的看法。
此外，EHR采用率的提高和对患者满意度的重视也与医生职业倦怠率的上升相对应。[6][7] 先前的研究表明，EHR的采用可能是导致这一趋势的原因之一。[8] EHR导致的职业倦怠可能部分归因于医生登录系统花费大量时间，在门诊结束后还要长时间记录，以避免破坏医患关系。[9]
我们利用现有数据源来描述医生登录EHR的时间——包括白天以及门诊结束后的时间——与经过验证的患者满意度调查表现之间的关系。我们的零假设是，登录EHR时间的增加与患者满意度之间没有关系。
