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美国家庭医生对“有意义使用”的利弊看法。

Meaningful use's benefits and burdens for US family physicians.

机构信息

Center for Ergonomics, University of Louisville, Louisville, KY, USA.

Department of Industrial Engineering, University of Louisville, Louisville, KY, USA.

出版信息

J Am Med Inform Assoc. 2018 Jun 1;25(6):694-701. doi: 10.1093/jamia/ocx158.

Abstract

OBJECTIVE

The federal meaningful use (MU) program was aimed at improving adoption and use of electronic health records, but practicing physicians have criticized it. This study was aimed at quantifying the benefits (ie, usefulness) and burdens (ie, workload) of the MU program for practicing family physicians.

MATERIALS AND METHODS

An interdisciplinary national panel of experts (physicians and engineers) identified the work associated with MU criteria during patient encounters. They conducted a national survey to assess each criterion's level of patient benefit and compliance burden.

RESULTS

In 2015, 480 US family physicians responded to the survey. Their demographics were comparable to US norms. Eighteen of 31 MU criteria were perceived as useful for more than half of patient encounters, with 13 of those being useful for more than two-thirds. Thirteen criteria were useful for less than half of patient encounters. Four useful criteria were reported as having a high compliance burden.

DISCUSSION

There was high variability in physicians' perceived benefits and burdens of MU criteria. MU Stage 1 criteria, which are more related to basic/routine care, were perceived as beneficial by most physicians. Stage 2 criteria, which are more related to complex and population care, were perceived as less beneficial and more burdensome to comply with.

CONCLUSION

MU was discontinued, but the merit-based incentive payment system within the Medicare Access and CHIP Reauthorization Act of 2015 adopted its criteria. For many physicians, MU created a significant practice burden without clear benefits to patient care. This study suggests that policymakers should not assess MU in aggregate, but as individual criteria for open discussion.

摘要

目的

联邦有意义使用(MU)计划旨在提高电子健康记录的采用和使用,但执业医师对此提出了批评。本研究旨在量化 MU 计划对执业家庭医生的益处(即有用性)和负担(即工作量)。

材料和方法

一个由跨学科的专家小组(医生和工程师)确定了在患者就诊期间与 MU 标准相关的工作。他们进行了一项全国性调查,以评估每个标准的患者受益程度和合规负担。

结果

2015 年,480 名美国家庭医生对调查做出了回应。他们的人口统计学特征与美国的规范相当。31 项 MU 标准中有 18 项被认为对超过一半的患者就诊有用,其中 13 项对超过三分之二的患者有用。13 项标准对不到一半的患者就诊有用。四项有用的标准被报告为具有较高的合规负担。

讨论

医生对 MU 标准的益处和负担的看法存在很大差异。MU 阶段 1 标准更与基本/常规护理相关,大多数医生认为这些标准是有益的。阶段 2 标准更与复杂和人群护理相关,被认为益处较小,合规负担较大。

结论

MU 已被停止,但 2015 年《医疗保险准入和儿童健康保险计划再授权法案》中的基于绩效的激励支付系统采用了其标准。对许多医生来说,MU 给他们的实践带来了巨大的负担,而对患者护理没有明显的益处。本研究表明,政策制定者不应该将 MU 作为一个整体进行评估,而应该作为个别标准进行公开讨论。

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