RAND Corporation, Boston, Massachusetts (R.S.R.).
Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts (M.W.F.).
Ann Intern Med. 2020 Jun 2;172(11 Suppl):S130-S136. doi: 10.7326/M19-0878.
Electronic health records (EHRs) are now widely adopted in the United States, but health systems have barely begun using them to deliver high-value care. More directed and rigorous research is needed to fulfill the promise of EHRs to not only store information but also support the delivery of better care. This article describes 4 potential benefits of EHR-based research: improving clinical decisions, supporting triage decisions, enabling collaboration among the care team (including patients), and increasing productivity via automation of tasks. Six recommendations are made for conducting and reporting research to catalyze value creation: develop interventions systematically by using user-centered design and a building-block approach; assess value in terms of cost, quality, outcomes, and work required of providers and patients; consider the time horizon for the intervention; test best practices for implementation in a range of real-world contexts; assess subtleties of behavior change tools used to improve high-value behaviors; and report the intervention in enough detail that it can be replicated, including context. Just as research played a critical role in developing early EHR prototypes and demonstrating their value to justify dissemination, research will continue to be essential in the next phase: expanding EHR-based interventions and maximizing their role in creating value.
电子健康记录 (EHR) 如今已在美国广泛采用,但医疗系统几乎尚未开始利用其提供高价值的医疗服务。为了实现 EHR 不仅存储信息,而且支持提供更好的医疗服务的承诺,还需要更有针对性和更严格的研究。本文介绍了基于 EHR 的研究的 4 个潜在优势:改善临床决策、支持分诊决策、支持医疗团队(包括患者)之间的协作,以及通过任务自动化提高生产力。为了促进价值创造,本文提出了 6 条进行和报告研究的建议:通过采用以用户为中心的设计和积木式方法有系统地开发干预措施;根据成本、质量、结果以及提供者和患者所需的工作来评估价值;考虑干预措施的时间范围;在各种真实环境中测试实施最佳实践;评估用于改善高价值行为的行为改变工具的细微差别;以及详细报告干预措施,包括背景,以便能够复制。正如研究在开发早期 EHR 原型和证明其传播价值方面发挥了关键作用一样,研究在接下来的阶段也将继续发挥重要作用:扩展基于 EHR 的干预措施并最大限度地发挥其在创造价值方面的作用。