Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Level 2, Charles Perkins Centre D17, Sydney, NSW, Australia.
Sydney West Translational Cancer Research Centre, Westmead Hospital, Sydney, NSW, Australia.
BMC Health Serv Res. 2021 Jan 6;21(1):23. doi: 10.1186/s12913-020-06015-6.
Electronic Medical Records (EMRs) are one of a range of digital health solutions that are key enablers of the data revolution transforming the health sector. They offer a wide range of benefits to health professionals, patients, researchers and other key stakeholders. However, effective implementation has proved challenging.
A qualitative methodology was used in the study. Interviews were conducted with 12 clinical and administrative staff of a cancer centre at one-month pre-launch and eight clinical and administrative staff at 12-months post-launch of an EMR. Data from the interviews was collected via audio recording. Audio recordings were transcribed, de-identified and analysed to identify staff experiences with the EMR.
Data from the pre-implementation interviews were grouped into four categories: 1) Awareness and understanding of EMR; 2) Engagement in launch process; 3) Standardisation and completeness of data; 4) Effect on workload. Data from the post-launch interviews were grouped into six categories: 1) Standardisation and completeness of data; 2) Effect on workload; 3) Feature completeness and functionality; 4) Interaction with technical support; 5) Learning curve; 6) Buy-in from staff. Two categories: Standardisation and completeness of data and effect on workload were common across pre and post-implementation interviews.
Findings from this study contribute new knowledge on barriers and enablers to the implementation of EMRs in complex clinical settings. Barriers to successful implementation include lack of technical support once the EMR has launched, health professional perception the EMR increases workload, and the learning curve for staff adequately familiarize themselves with using the EMR.
电子病历（EMR）是一系列数字健康解决方案之一，是推动医疗领域数据革命的关键推动因素。它们为医疗专业人员、患者、研究人员和其他利益攸关方提供了广泛的益处。然而，有效的实施被证明是具有挑战性的。
本研究采用定性方法。在电子病历推出前一个月，对一家癌症中心的 12 名临床和行政人员进行了访谈，在推出 12 个月后对 8 名临床和行政人员进行了访谈。访谈通过录音收集数据。对录音进行转录、去识别和分析，以确定员工对 EMR 的体验。
实施前访谈的数据分为四类：1）对 EMR 的认识和理解；2）参与启动过程；3）数据的标准化和完整性；4）对工作量的影响。实施后访谈的数据分为六类：1）数据的标准化和完整性；2）对工作量的影响；3）功能的完整性和功能；4）与技术支持的交互；5）学习曲线；6）员工的认同。前和实施后访谈中都有两个类别：数据的标准化和完整性以及对工作量的影响。
本研究的结果为在复杂临床环境中实施 EMR 的障碍和促进因素提供了新知识。成功实施的障碍包括电子病历推出后缺乏技术支持、医疗专业人员认为电子病历增加了工作量以及员工充分熟悉使用电子病历的学习曲线。
