Alberta Health Services, Edmonton, Alberta, Canada.
Department of Nursing, Yale University, Orange, Connecticut, United States.
Appl Clin Inform. 2018 Oct;9(4):817-830. doi: 10.1055/s-0038-1675210. Epub 2018 Nov 14.
Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices.
This article outlines the development of a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs.
A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low).
An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis, items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist.
Safe implementation of EHRs requires consideration of both technical and sociotechnical factors through close collaboration of health information technology and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.
电子健康记录 (EHR) 正在改变医疗保健的提供方式。它们是提高患者护理质量的核心，并且已经使医疗保健更加便捷、可靠和安全。然而，近年来的证据表明，EHR 的特定功能和特性可能会引入新的、意料之外的患者安全问题，这些问题可以通过安全配置实践来缓解。
本文概述了为临床信息学专业人员在配置基于医院的 EHR 时使用而制定的详细且全面的基于证据的安全配置实践清单的开发过程。
进行了文献回顾，以综合有关安全配置实践的证据；分析数据以引出常见 EHR 系统功能的主题。与最终用户进行了两轮测试，以告知清单设计和可用性。随后，由四名专家组成的小组进行了审查，对每个项目的清晰度（清晰、不清晰）和重要性（高、中、低）进行了评分。
由三名临床信息学专业人员和一名健康信息技术专家组成的专家小组对清单的清晰度和重要性进行了审查。中高度重要性评分被认为是肯定的回答。在最初的清单中包含的 870 个项目中，所有四名小组成员都对 535 个（61.4%）项目达成了 100%的肯定协议。临床小组成员的肯定协议率更高，为 75.5%（656 个项目）。经过详细分析，在清单中保留了 100%的临床医生同意的项目，但排除了 47 个项目，并增加了 33 个项目，最终清单总计 642 个项目。
EHR 的安全实施需要通过健康信息技术和临床信息学专业人员的密切合作考虑技术和社会技术因素。本清单中描述的推荐实践为配置、实施、审核或更新 EHR 时提供了系统实施指南，以提高系统的安全性和可用性。
