Population Health Program, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 7K4, Canada.
Bruyère Continuing Care, Ottawa, Ontario, Canada.
BMC Med Inform Decis Mak. 2021 Feb 19;21(1):67. doi: 10.1186/s12911-021-01434-9.
Despite a substantial increase in the adoption of electronic medical records (EMRs) in primary health care settings, the use of advanced EMR features is limited. Several studies have identified both barriers and facilitating factors that influence primary care physicians' (PCPs) use of advanced EMR features and the maturation of their EMR use. The purpose of this study is to explore and identify the factors that impact PCPs' mature use of EMRs.
A systematic review was conducted in accordance with the Cochrane Handbook. The MEDLINE, Embase, and PsycINFO electronic databases were searched from 1946 to June 13, 2019. Two independent reviewers screened the studies for eligibility; to be included, studies had to address factors influencing PCPs' mature use of EMRs. A narrative synthesis was conducted to collate study findings and to report on patterns identified across studies. The quality of the studies was also appraised.
Of the 1893 studies identified, 14 were included in this study. Reported factors that influenced PCPs' mature use of EMRs fell into one of the following 5 categories: technology, people, organization, resources, and policy. Concerns about the EMR system's functionality, lack of physician awareness of EMR functionality, limited physician availability to learn more about EMRs, the habitual use of successfully completing clinical tasks using only basic EMR features, business-oriented organizational objectives, lack of vendor training, limited resource availability, and lack of physician readiness were reported as barriers to PCPs' mature use of EMRs. The motivation of physicians, user satisfaction, coaching and peer mentoring, EMR experience, gender, physician perception, transition planning for changes in roles and work processes, team-based care, adequate technical support and training, sharing resources, practices affiliated with an integrated delivery system, financial incentives, and policies to increase EMR use all had a favorable impact on PCPs' use of advanced EMR features.
By using a narrative synthesis to synthesize the evidence, we identified interrelated factors influencing the mature use of EMRs by PCPs. The findings underline the need to provide adequate training and policies that facilitate the mature use of EMRs by PCPs.
PROSPERO CRD42019137526.
尽管电子病历（EMR）在基层医疗保健环境中的采用率大幅提高，但高级 EMR 功能的使用仍受到限制。多项研究已经确定了影响初级保健医生（PCP）使用高级 EMR 功能和 EMR 使用成熟度的障碍和促进因素。本研究的目的是探索和确定影响 PCP 成熟使用 EMR 的因素。
按照 Cochrane 手册进行系统评价。从 1946 年至 2019 年 6 月 13 日，检索了 MEDLINE、Embase 和 PsycINFO 电子数据库。两名独立评审员筛选了符合条件的研究；为了被纳入，研究必须解决影响 PCP 成熟使用 EMR 的因素。采用叙述性综合方法整理研究结果，并报告研究之间的模式。还对研究的质量进行了评估。
在 1893 项研究中，有 14 项研究纳入本研究。报告的影响 PCP 成熟使用 EMR 的因素分为以下 5 类：技术、人员、组织、资源和政策。对 EMR 系统功能的担忧、医生对 EMR 功能缺乏认识、医生缺乏学习更多 EMR 知识的机会、习惯性地使用仅具有基本 EMR 功能成功完成临床任务、以业务为导向的组织目标、供应商培训不足、资源有限以及医生准备不足被报告为 PCP 成熟使用 EMR 的障碍。医生的动机、用户满意度、辅导和同行指导、EMR 经验、性别、医生感知、角色和工作流程变更的过渡计划、团队为基础的护理、充足的技术支持和培训、资源共享、与综合交付系统相关联的实践、经济激励以及增加 EMR 使用的政策对 PCP 使用高级 EMR 功能都有积极的影响。
通过使用叙述性综合方法综合证据，我们确定了影响 PCP 成熟使用 EMR 的相互关联的因素。研究结果强调需要提供足够的培训和政策，以促进 PCP 成熟使用 EMR。
PROSPERO CRD42019137526。
