Morquin D
Département des Maladies Infectieuses et Tropicales - CHU de Montpellier, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France; Délégation à l'Usage clinique du Numérique, CHU de Montpellier - Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France.
Rev Med Interne. 2020 Sep;41(9):617-621. doi: 10.1016/j.revmed.2020.03.011. Epub 2020 May 25.
The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.
这篇简短的叙述性文献综述的目的是强调医生在日常使用电子病历(EMR)过程中遇到的各种困难。我们表明,这些并非与“抗拒变革”相关的简单过渡现象,而是更深层次且未完成的转变这一事实。除了“对与工作流程不匹配的感知”或自主性丧失的威胁之外,我们建议从EMR引发的医疗工作形式化角度来分析这种所谓的“抗拒”。我们的问题涉及EMR多个目标的兼容性、计算机化对医疗信息录入和查阅步骤的潜在影响、对临床推理的影响、对医疗“绩效”辅助的实际情况。问题不在于EMR相比纸质记录在哪方面做得不好,而在于深入了解未来的EMR如何能比当下的做得更好。