电子记录与实施电子病历系统前的纸质记录对医疗保健专业人员对电子病历系统使用、数据质量和数据再利用的看法的影响。
Impact of Electronic versus Paper-Based Recording before EHR Implementation on Health Care Professionals' Perceptions of EHR Use, Data Quality, and Data Reuse.
机构信息
Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
出版信息
Appl Clin Inform. 2019 Mar;10(2):199-209. doi: 10.1055/s-0039-1681054. Epub 2019 Mar 20.
BACKGROUND
The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation.
OBJECTIVE
To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation.
METHODS
We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit.
RESULTS
We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation.
CONCLUSION
Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.
背景
通过电子健康记录（EHR）实现结构化和标准化的患者数据记录，可以提高数据质量和可重用性。用户是否以及如何感知到这些优势可能取决于实施前的情况。
目的
确定在实施结构化和标准化 EHR 之前，使用纸质记录与使用遗留 EHR 的用户，其对 EHR 使用、数据质量和数据重用的感知是否受到实施的影响不同。
方法
我们使用电子问卷在三个主题上测量用户在实施前（2014 年）、预期变化和实施后（2016 年）的感知。我们包括了荷兰两家大学医院的所有医疗保健专业人员。在共同实施相同的结构化和标准化 EHR 之前，一家医院使用纸质记录，另一家使用遗留 EHR。我们比较了两个中心实施前后的看法。此外，我们比较了预期收益和感知收益。
结果
我们收到了 7611 份回复（实施前 4537 份，实施后 3074 份），其中 5707 份（75%）来自阅读和记录患者数据的专业人员。共有 975 名（13%）专业人员对前后两次调查问卷做出了回应。在以前的纸质中心，工作人员在实施后所有主题的感知都有所改善。遗留 EHR 中心经历了 EHR 使用和数据重用感知的恶化，只有一个 EHR 使用的改善。在两个中心，对于一半的方面，至少有 45%的应答者经历的结果比实施前的预期更差。
结论
我们的结果表明，实施前的记录实践会影响对结构化和标准化 EHR 实施的感知效果。对于将近一半的受访者来说，新的 EHR 没有达到他们的期望。特别是遗留 EHR 中心需要调查这些期望，因为它们可能与纸质中心的期望不同，也不那么明确。这些期望需要得到适当的解决，以实现成功的实施。
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