University of North Carolina at Charlotte, Charlotte, NC.
Wake Forest School of Medicine, Winston-Salem, NC.
JCO Clin Cancer Inform. 2021 May;5:527-540. doi: 10.1200/CCI.20.00174.
Accurate recording of diagnosis (DX) data in electronic health records (EHRs) is important for clinical practice and learning health care. Previous studies show statistically stable patterns of data entry in EHRs that contribute to inaccurate DX, likely because of a lack of data entry support. We conducted qualitative research to characterize the preferences of oncological care providers on cancer DX data entry in EHRs during clinical practice.
We conducted semistructured interviews and focus groups to uncover common themes on DX data entry preferences and barriers to accurate DX recording. Then, we developed a survey questionnaire sent to a cohort of oncologists to verify the generalizability of our initial findings. We constrained our participants to a single specialty and institution to ensure similar clinical backgrounds and clinical experience with a single EHR system.
A total of 12 neuro-oncologists and thoracic oncologists were involved in the interviews and focus groups. The survey developed from these two initial thrusts was distributed to 19 participants yielding a 94.7% survey response rate. Clinicians reported similar user interface experiences, barriers, and dissatisfaction with current DX entry systems including repetitive entry operations, difficulty in finding specific DX options, time-consuming interactions, and the need for workarounds to maintain efficiency. The survey revealed inefficient DX search interfaces and challenging entry processes as core barriers.
Oncologists seem to be divided between specific DX data entry and time efficiency because of current interfaces and feel hindered by the burdensome and repetitive nature of EHR data entry. Oncologists' top concern for adopting data entry support interventions is ensuring that it provides significant time-saving benefits and increasing workflow efficiency. Future interventions should account for time efficiency, beyond ensuring data entry effectiveness.
电子健康记录（EHR）中准确记录诊断（DX）数据对于临床实践和学习型医疗保健至关重要。先前的研究表明，EHR 中的数据录入存在统计学上稳定的模式，这导致 DX 不准确，可能是由于缺乏数据录入支持。我们进行了定性研究，以描述临床实践中肿瘤学护理提供者对 EHR 中癌症 DX 数据录入的偏好。
我们进行了半结构化访谈和焦点小组讨论，以揭示 DX 数据录入偏好和准确 DX 记录障碍的常见主题。然后，我们开发了一份问卷调查表，发送给一组肿瘤学家，以验证我们初步发现的普遍性。我们将参与者限制在单一专业和机构内，以确保具有相似的临床背景和单一 EHR 系统的临床经验。
共有 12 名神经肿瘤学家和胸肿瘤学家参与了访谈和焦点小组。从这两个初始方向发展而来的调查，分发给 19 名参与者，调查回复率为 94.7%。临床医生报告了类似的用户界面体验、障碍和对当前 DX 录入系统的不满，包括重复录入操作、难以找到特定 DX 选项、耗时的交互以及保持效率的需要。调查显示，低效的 DX 搜索界面和具有挑战性的录入流程是核心障碍。
由于当前的界面，肿瘤学家似乎在特定的 DX 数据录入和时间效率之间存在分歧，并因 EHR 数据录入的繁琐和重复性质而受到阻碍。肿瘤学家对采用数据录入支持干预措施的首要关注是确保它提供显著的节省时间的好处并提高工作流程效率。未来的干预措施应考虑到时间效率，而不仅仅是确保数据录入的有效性。
