医疗机构和卫生专业人员对电子病历系统实施的准备情况：对当前埃塞俄比亚西北部电子病历实施的启示。
Organizational and health professional readiness for the implementation of electronic medical record system: an implication for the current EMR implementation in northwest Ethiopia.
机构信息
Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
eHealth Lab Ethiopia, University of Gondar, Gondar, Ethiopia.
出版信息
BMJ Health Care Inform. 2023 Mar;30(1). doi: 10.1136/bmjhci-2022-100723.
OBJECTIVE
The WHO developed a manual outlining the preliminary organizational and health professionals' readiness to implement electronic medical records (EMR). On the other hand, the readiness assessment in Ethiopia only includes the evaluation of health professionals, leaving out organisational readiness components. As a result, this research aimed to determine health professionals' and organizational readiness to implement EMR at a specialized teaching hospital.
METHODS
An institutional-based cross-sectional study design was conducted among 423 health professionals and 54 managers. Self-administered and pretested questionnaires were used to collect data. Binary logistic regression analysis was used to identify factors associated with health professionals' readiness for EMR implementation. An OR with a 95% CI and p<0.05 was used to determine the strength of the association and the statistical significance, respectively.
RESULTS
In this study, 53.7% management capacity, 33.3% finance and budget capacity, 42.6% operational capacity, 37.0% technology capability and 53.7% organisational alignment among the five dimensions evaluated to assess an organisation's readiness to implement an EMR system. Of 411 health professionals in this study, 173 (42.1%) with (95 CI 37.3% to 46.8%) were ready to implement an EMR system at the hospital. Sex (AOR 2.69, 95% CI 1.73 to 4.18), basic computer training (AOR 1.59, 95% CI 1.02 to 2.46), knowledge of EMR (AOR 1.88, 95% CI 1.19 to 2.97) and attitudes towards EMR (AOR 1.65, 95% CI 1.05 to 2.59) were significantly associated with health professionals' readiness towards EMR system implementation.
CONCLUSIONS
Findings showed that most dimensions of organizational readiness for EMR implementation were below 50%. This study also revealed a lower level of EMR implementation readiness among health professionals compared with previous research studies' results. To improve organisational readiness to implement an electronic medical record system, a focus on management capability, financial and budget capability, operational capability, technical capability and organisational alignment was crucial. Likewise, having basic computer training, giving special attention to female health professionals and improving health professionals' knowledge of and attitudes towards EMR could help improve the readiness level of health professionals for implementing an EMR system.
目的
世界卫生组织（WHO）制定了一份手册，概述了初步的组织和卫生专业人员准备情况，以实施电子病历（EMR）。另一方面，埃塞俄比亚的准备情况评估仅包括对卫生专业人员的评估，而忽略了组织准备情况的组成部分。因此，本研究旨在确定专门教学医院的卫生专业人员和组织对实施 EMR 的准备情况。
方法
采用基于机构的横断面研究设计，对 423 名卫生专业人员和 54 名管理人员进行调查。使用自我管理和预测试问卷收集数据。使用二元逻辑回归分析确定与卫生专业人员 EMR 实施准备相关的因素。使用 OR 及其 95%CI 和 p<0.05 来确定关联的强度和统计显著性。
结果
在这项研究中，在所评估的五个维度中，管理能力为 53.7%、财务和预算能力为 33.3%、运营能力为 42.6%、技术能力为 37.0%、组织一致性为 53.7%，以评估组织实施 EMR 系统的准备情况。在这项研究的 411 名卫生专业人员中，有 173 名（95%CI 为 37.3%至 46.8%）准备好在医院实施 EMR 系统。性别（AOR 2.69，95%CI 为 1.73 至 4.18）、基本计算机培训（AOR 1.59，95%CI 为 1.02 至 2.46）、EMR 知识（AOR 1.88，95%CI 为 1.19 至 2.97）和对 EMR 的态度（AOR 1.65，95%CI 为 1.05 至 2.59）与卫生专业人员对 EMR 系统实施的准备情况显著相关。
结论
研究结果表明，EMR 实施组织准备情况的大多数维度都低于 50%。本研究还表明，与之前的研究结果相比，卫生专业人员的 EMR 实施准备程度较低。为了提高组织实施电子病历系统的准备情况，必须关注管理能力、财务和预算能力、运营能力、技术能力和组织一致性。同样，提供基本的计算机培训，特别关注女性卫生专业人员，并提高卫生专业人员对 EMR 的知识和态度，可以帮助提高卫生专业人员对实施 EMR 系统的准备程度。
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