Lanier Cédric, Cerutti Bernard, Dominicé Dao Melissa, Hudelson Patricia, Junod Perron Noëlle
Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland,
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Int J Gen Med. 2018 Oct 9;11:393-398. doi: 10.2147/IJGM.S178672. eCollection 2018.
The use of electronic health records (EHRs) by physicians during the consultation is common and can be problematic. Factors influencing the use of EHRs during clinical encounters include physician and patient characteristics, consultation type as well as spatial organization of the room and type of EHR template. Their relative importance is however not well known. This study aimed to explore to what extent several physician, patient and consultation factors were associated with EHR use during the first 10 minutes of primary care consultations.
We examined EHR use of 17 residents in 142 videotaped consultations at the Primary Care Division of the Geneva University Hospitals, Switzerland. We conducted univariable and multivariable analyses with patient, physician and consultation variables to predict EHR use: sex and age of the patient; physician's sex, age, postgraduate experience and EHR-use self-perception; and language, type of consultation (new/follow-up) and content of the consultation using the Roter interaction analysis system (RIAS), the main variable being the percentage of utterances in relation to EHR use during the first 10 minutes.
Male physicians (residents) and those with less clinical experience and conducting a new consultation or addressing biomedical content were positively correlated with EHR use (+5.3% for male physicians, =0.101; +0.6% per year of experience, =0.021; +6.0% for new consultation, =0.097; +0.4% per 1% of biomedical content increase; =0.018).
Only a small number of physician, patient and consultation factors appear to have an impact on the use of EHR during primary care consultations, and this impact remains modest. Given the influence of EHR use on physician-patient relationship, further research should explore what other factors are implicated in EHR use and whether they can be changed or improved.
医生在会诊期间使用电子健康记录（EHRs）很常见，但可能存在问题。影响临床会诊期间EHRs使用的因素包括医生和患者的特征、会诊类型以及房间的空间布局和EHR模板类型。然而，它们的相对重要性尚不清楚。本研究旨在探讨在初级保健会诊的前10分钟内，几种医生、患者和会诊因素与EHR使用的关联程度。
我们在瑞士日内瓦大学医院初级保健科对17名住院医生的142次录像会诊中的EHR使用情况进行了检查。我们对患者、医生和会诊变量进行了单变量和多变量分析，以预测EHR的使用情况：患者的性别和年龄；医生的性别、年龄、研究生学历后的工作经验以及对EHR使用的自我认知；以及使用罗特尔互动分析系统（RIAS）的会诊语言、类型（新诊/复诊）和内容，主要变量是前10分钟内与EHR使用相关的话语百分比。
男性医生（住院医生）、临床经验较少、进行新会诊或涉及生物医学内容的医生与EHR使用呈正相关（男性医生增加5.3%，P = 0.101；每年经验增加0.6%，P = 0.021；新会诊增加6.0%，P = 0.097；生物医学内容每增加1%增加0.4%，P = 0.018）。
在初级保健会诊期间，只有少数医生、患者和会诊因素似乎会对EHR的使用产生影响，而且这种影响仍然较小。鉴于EHR使用对医患关系的影响，进一步的研究应探讨EHR使用中还涉及哪些其他因素，以及它们是否可以改变或改善。
