School of Nursing, Duke University, Durham, North Carolina, USA.
System Provider Informatics, Providence Health, Richland, Washington, USA.
J Am Med Inform Assoc. 2021 Mar 18;28(4):824-831. doi: 10.1093/jamia/ocaa333.
The purpose of the study was to determine if association exists between evidence-based provider training and clinician proficiency in electronic health record (EHR) use and if so, which EHR use metrics and vendor-defined indices exhibited association.
We studied ambulatory clinicians' EHR use data published in the Epic Systems Signal report to assess proficiency between training participants (n = 133) and nonparticipants (n = 14). Data were collected in May 2019 and November 2019 on nonsurgeon clinicians from 6 primary care, 7 urgent care, and 27 specialty care clinics. EHR use training occurred from August 5 to August 15, 2019, prior to EHR upgrade and organizational instance alignment. Analytics performed were descriptive statistics, paired t-tests, multivariate correlations, and hierarchal multiple regression.
For number of appointments per 30-day reporting period, trained clinicians sustained an average increase of 16 appointments (P < .05), whereas nontrained clinicians incurred a decrease of 8 appointments. Only the trained clinician group achieved postevent improvement in the vendor-defined Proficiency score with an effect size characterized as moderate to large (dCohen = 0.625).
Controversies exist on the return of investment from formal EHR training for clinician users. Previously published literature has mostly focused on qualitative data indicators of EHR training success. The findings of our EHR use training study identified EHR use metrics and vendor-defined indices with the capacity for translation into productivity and generated revenue measurements.
One EHR use metric and 1 vendor-defined index indicated improved proficiency among trained clinicians.
本研究旨在确定基于证据的提供者培训与临床医生在电子健康记录(EHR)使用方面的熟练程度之间是否存在关联,如果存在关联,那么哪些 EHR 使用指标和供应商定义的指标存在关联。
我们研究了发表在 Epic Systems Signal 报告中的门诊临床医生的 EHR 使用数据,以评估培训参与者(n=133)和非参与者(n=14)之间的熟练程度。数据于 2019 年 5 月和 11 月在来自 6 个初级保健、7 个紧急护理和 27 个专科护理诊所的非外科临床医生中收集。EHR 使用培训于 2019 年 8 月 5 日至 8 月 15 日进行,在此之前进行了 EHR 升级和组织实例调整。进行的分析包括描述性统计、配对 t 检验、多元相关分析和层次多重回归。
在每 30 天报告期的预约次数方面,接受培训的临床医生平均增加了 16 次预约(P<0.05),而未接受培训的临床医生则减少了 8 次预约。只有接受培训的临床医生组在供应商定义的熟练程度评分方面取得了事件后的改善,其效应大小被描述为中等至较大(dCohen=0.625)。
关于临床医生用户从正式的 EHR 培训中获得投资回报存在争议。以前发表的文献主要集中在 EHR 培训成功的定性数据指标上。我们的 EHR 使用培训研究的结果确定了 EHR 使用指标和供应商定义的指标,这些指标具有转化为生产力和产生收入的能力。
一项 EHR 使用指标和一项供应商定义的指标表明,接受培训的临床医生的熟练程度有所提高。