Ash Joan S, Chase Dian, Baron Sherry, Filios Margaret S, Shiffman Richard N, Marovich Stacey, Wiesen Jane, Luensman Genevieve B
Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States.
Department of Urban Studies, Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, New York, United States.
Appl Clin Inform. 2020 Aug;11(4):635-643. doi: 10.1055/s-0040-1715895. Epub 2020 Sep 30.
Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices.
This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings.
We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations.
We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work.
We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.
尽管有工作且存在相关健康问题的患者通常首先在初级保健机构就诊，但这些机构的医护人员通常不会常规询问有关工作的问题。帮助管理此类患者的指南在初级保健中很少被使用。具备员工健康临床决策支持（CDS）工具的电子健康记录（EHR）系统有潜力辅助这些医疗实践。
本研究旨在确定在各种初级保健环境中，为有工作的患者进行临床管理而实施CDS工具的需求、障碍和促进因素。
我们采用了定性设计，包括对来自五个组织的10家诊所的访谈记录和观察现场笔记进行分析。
我们采访了83名医护人员、工作人员、管理人员、信息学和信息技术专家以及负责人，并进行了35小时的观察。我们在与员工健康CDS相关的四个类别中确定了八个主题（操作问题、拟议CDS的实用性、与努力和时间相关的问题以及特定主题问题）。这些类别被归类为使用CDS工具的促进因素或障碍。与操作问题相关的促进因素包括当前的技术可行性以及与协调护理模式相关的新工作模式。与实用性相关的促进因素包括用户对提高认识和循证工具的需求、拟议CDS对其患者的适用性以及人群健康数据的益处。与努力相关的障碍包括拟议的CDS可能需要额外的时间，以及其他紧迫的组织优先事项。特定主题的障碍包括与健康和工作相关的敏感问题以及工作信息的复杂性。
我们发现了几个以前未描述过的主题，这些主题可以指导未来CDS的开发：拟议的CDS在商业EHR中的技术可行性、一些CDS内容的敏感性以及协助整个医疗团队管理员工健康的必要性。
