Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA.
J Am Med Inform Assoc. 2020 May 1;27(5):690-699. doi: 10.1093/jamia/ocaa010.
To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs.
In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users' information needs, which were then used to produce EHR design principles.
Analyses of > 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information.
Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.
确定为有复杂医疗、社会和经济需求的患者提供护理的临床团队的未满足信息需求；并提出重新设计电子健康记录（EHR）以满足这些需求的原则。
在这项观察性研究中，我们采访和观察了俄勒冈州和华盛顿州的 9 家社区卫生中心的护理团队，以了解他们在照顾有复杂医疗和社会经济需求的患者时使用 EHR 的情况。使用比较方法分析数据以确定 EHR 用户的信息需求，然后使用这些需求生成 EHR 设计原则。
对超过 300 小时的观察和 51 次访谈的分析确定了与以下四个主要类别的信息需求相关：健康的社会决定因素（SDH）文档的一致性；SDH 信息的优先级及其优先级的变化；社区资源转介的启动和跟进；以及 SDH 信息的及时沟通。在这些类别中，有 10 个未满足的信息需求需要由 EHR 设计师解决。我们提出了以下 EHR 设计原则来满足这些需求：增强 EHR 文档工作流程的灵活性；扩大团队内部和系统之间信息交换的能力；平衡健康信息技术系统的创新和标准化；组织和简化信息显示；以及优先处理和减少信息。
开发简单、可访问、易于使用且能够由各种专业人员更新的 EHR 工具至关重要。确定的信息需求和设计原则应告知在社区卫生中心和其他为接受护理的复杂患者提供服务的环境中工作的开发人员和实施人员。
