Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic.
Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
BMC Med Inform Decis Mak. 2020 Jul 13;20(1):159. doi: 10.1186/s12911-020-01160-8.
The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective.
An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added.
Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes.
EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.
为了方便评估和护理计划等文档记录实践，电子病历（EPR）已在养老院中引入，这些实践在提供痴呆症护理方面起着至关重要的作用。然而，从最终用户的角度来看，EPR 如何促进或阻碍这些实践，我们知之甚少。因此，本定性研究的目的是从员工的角度探讨与养老院中痴呆症患者的评估和护理计划相关的 EPR 使用问题。
采用探索性、定性研究设计和多案例研究方法。在比利时、捷克共和国和西班牙的三家养老院中，对使用 EPR 的各种员工（n=21）进行了情境调查。使用主题分析法对访谈数据进行编码，然后将代码分类为健康信息技术评估框架的先验组件：设备、软件功能、组织支持。此外，还添加了两个额外的主题，即结构和内容。
员工提供了许多 EPR 系统在每个组件下促进和阻碍评估和护理计划的方式的例子，特别是对于痴呆症患者，他们可能比其他居民有更复杂的需求。EPR 系统不可定制是这三个养老院的共同主题。对组织政策和实践的比较揭示了培训、系统支持和访问的重要性，这可能与 EPR 系统在养老院中的成功采用有关。
引入养老院环境的 EPR 系统应该是可定制的，并反映痴呆症护理的最佳实践指南，这可能会提高养老院中痴呆症患者的生活质量和生活质量。应在 EPR 系统的开发、实施和评估过程中咨询养老院各级员工，作为迭代的、以用户为中心的设计过程的一部分。
