National Institute for Health and Welfare (THL), Department of Health and Social Care Systems, P.O Box 30, FI-00271, Helsinki, Finland.
University of Oulu, Finntelemedicum, Research Unit of Medical Imaging, Physics and Technology, Oulu, Finland; Hospital of Raahe, Department of Radiology, Raahe, Finland.
Int J Med Inform. 2019 Feb;122:1-6. doi: 10.1016/j.ijmedinf.2018.11.005. Epub 2018 Nov 23.
Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE).
The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development.
Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland.
Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender.
Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.
在医疗保健服务的连续体中，需要及时、完整和准确的患者数据来做出护理决策。为了从其他组织获取患者数据，芬兰目前使用三种类型的区域卫生信息交换系统（RHIS）。一些地区使用多种 RHIS，而另一些地区则没有可用的 RHIS。最近推出的国家患者数据存储库（Kanta）越来越多地用于健康信息交换（HIE）。
本研究旨在评估 2017 年不同情境下纸张、RHIS 和 Kanta 的使用情况；多年来纸张使用情况的演变；以及 2017 年芬兰医生用于 HIE 系统开发的纸张使用的预测因素。
电子健康记录（EHR）使用情况和用户体验调查的数据来自 2010 年（电子处方系统实施之前）、2014 年（Kanta 实施之前）和 2017 年（Kanta 在公共部门和大型私营组织中全面使用）。这些基于网络的调查针对的是在芬兰从事临床工作的所有医生。
Kanta 是 2017 年最常用的 HIE 手段。与 2010 年相比，纸张的使用量在 2014 年显著减少。这一趋势在 2017 年仍在继续。尽管如此，截至 2017 年，仍有一半的医生报告每天或每周使用纸张。纸质文档的使用在医疗保健部门、可用 RHIS 类型和使用的 EHR 系统之间存在很大差异。在多变量分析中（所有其他变量保持不变），与电子方式相比，更频繁地使用纸张进行 HIE 的预测因素包括：私营部门或医院、访问主患者索引 RHIS（类型 1）、多个 RHIS（类型 4）或没有 RHIS（类型 5）、两个特定的 EHR 系统、年龄较大、经验较少、手术、精神科或诊断专业以及男性性别。
需要改进 HIE 系统（包括 EHR）的可用性，作为访问 HIE 的切入点，以促进电子 HIE 的使用。使用可确保更及时、更完整的患者数据，以实现安全、协调的护理。特定于专业的需求和要求需要更多的用户参与 HIE 设计。特别是老年专业人员需要接受培训，以便更好地利用 HIS 进行 HIE。
