Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, MI, USA.
Office of Medical Education, A.T. Still University of Osteopathic Medicine, Mesa, AZ, USA.
J Am Med Inform Assoc. 2018 Jun 1;25(6):686-693. doi: 10.1093/jamia/ocx153.
Ensuring the ability to exchange patient information among disparate electronic health records systems is a top priority and a domain of substantial public investment across countries. However, we know little about the extent to which current capabilities meet the needs of frontline clinicians.
We conducted in-person, semistructured interviews with emergency care physicians and nurses in select hospitals in Canada, Denmark, Finland, Germany, and the USA. We characterized the state of health information exchange (HIE) by country and used thematic analysis to identify the perceived benefits of access to complete past medical history (PMH), the conditions under which PMH is sought, and the challenges to accessing and using HIE capabilities.
HIE approaches, and the information electronically accessible to clinicians, differed by country. Benefits of access to PMH included safer care, reduced patient length of stay, and fewer lab and imaging orders. Conditions under which PMH was sought included moderate-acuity patients, patients with chronic conditions, and instances where accessing PMH was convenient. Challenges to HIE access and use included difficulty knowing where information is located, delay in receiving information, and difficulty finding information within documents.
Even with different HIE approaches across countries, all clinicians reported shortcomings in their country's approach. Notably, challenges were similar and shaped the conditions under which PMH was sought.
As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another.
确保不同电子健康记录系统之间能够交换患者信息，这是各国的首要任务，也是大量公共投资的领域。然而，我们对当前能力在多大程度上满足一线临床医生的需求知之甚少。
我们在加拿大、丹麦、芬兰、德国和美国的选定医院对急诊医生和护士进行了面对面的半结构化访谈。我们根据国家描述了健康信息交换（HIE）的现状，并使用主题分析来确定访问完整既往病史（PMH）的好处、寻求 PMH 的条件以及访问和使用 HIE 功能的挑战。
HIE 方法以及临床医生可电子访问的信息因国家而异。访问 PMH 的好处包括更安全的护理、减少患者住院时间和减少实验室和影像学检查的数量。寻求 PMH 的条件包括中度急性患者、患有慢性疾病的患者以及在方便获取 PMH 的情况下。HIE 访问和使用的挑战包括难以了解信息的位置、信息接收延迟以及在文档中查找信息的困难。
即使在不同国家有不同的 HIE 方法，所有临床医生都报告了他们国家方法的不足之处。值得注意的是，挑战是相似的，并塑造了寻求 PMH 的条件。
随着各国继续追求广泛的 HIE，他们似乎在实现 HIE 价值方面面临着类似的挑战，因此有机会相互学习。
