Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2021 Jul 14;28(7):1555-1563. doi: 10.1093/jamia/ocab057.
The study sought to develop an in-depth understanding of how hospitals with a long history of health information technology (HIT) use have responded to the COVID-19 (coronavirus disease 2019) pandemic from an HIT perspective.
We undertook interviews with 44 healthcare professionals with a background in informatics from 6 hospitals internationally. Interviews were informed by a topic guide and were conducted via videoconferencing software. Thematic analysis was employed to develop a coding framework and identify emerging themes.
Three themes and 6 subthemes were identified. HITs were employed to manage time and resources during a surge in patient numbers through fast-tracked governance procedures, and the creation of real-time bed capacity tracking within electronic health records. Improving the integration of different hospital systems was identified as important across sites. The use of hard-stop alerts and order sets were perceived as being effective at helping to respond to potential medication shortages and selecting available drug treatments. Utilizing information from multiple data sources to develop alerts facilitated treatment. Finally, the upscaling/optimization of telehealth and remote working capabilities was used to reduce the risk of nosocomial infection within hospitals.
A number of the HIT-related changes implemented at these sites were perceived to have facilitated more effective patient treatment and management of resources. Informaticians generally felt more valued by hospital management as a result.
Improving integration between data systems, utilizing specialized alerts, and expanding telehealth represent strategies that hospitals should consider when using HIT for delivering hospital care in the context of the COVID-19 pandemic.
本研究旨在从医疗信息技术(HIT)的角度深入了解具有悠久 HIT 使用历史的医院如何应对 COVID-19(冠状病毒病 2019)大流行。
我们对来自国际 6 家医院的 44 名具有信息学背景的医疗保健专业人员进行了访谈。访谈以主题指南为依据,并通过视频会议软件进行。采用主题分析方法制定编码框架并确定新出现的主题。
确定了三个主题和六个子主题。通过快速跟踪治理程序和在电子病历中创建实时床位容量跟踪,HIT 被用于管理患者数量激增期间的时间和资源。各医院之间提高不同系统集成度被认为是重要的。使用硬停止警报和医嘱集被认为有助于应对潜在的药物短缺和选择可用药物治疗。利用来自多个数据源的信息开发警报有助于治疗。最后,扩大/优化远程医疗和远程工作能力,以降低医院内医院感染的风险。
这些地点实施的一些与 HIT 相关的变化被认为有助于更有效地治疗患者和管理资源。因此,医院管理人员普遍认为信息学家的价值更高。
改善数据系统之间的集成,利用专门的警报以及扩大远程医疗代表了医院在 COVID-19 大流行背景下使用 HIT 提供医院护理时应考虑的策略。