Robertson Samantha T, Brauer Sandra G, Burton-Jones Andrew, Grimley Rohan S, Rosbergen Ingrid Cm
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
Digit Health. 2024 Sep 28;10:20552076241279208. doi: 10.1177/20552076241279208. eCollection 2024 Jan-Dec.
This study sought to determine the use and perceived value of a user-centered electronic medical record (EMR) enhancement for stroke care and understand if its value was in alignment with its intended design. The EMR enhancement was introduced into Queensland public hospitals in Australia and included a summary page for enhanced interprofessional collaboration and data collection forms for efficient data extraction.
A mixed methods design was adopted and data collected from four hospital sites. We conducted 15 semistructured interviews with multidisciplinary end-users across participating sites and analyzed this data using inductive thematic techniques. Usage log data was extracted from the EMR to determine its use.
Relative use of the summary page showed moderate use, varying from 66 ± 22.5 uses for each stroke patient admission per month (Site 1) to 26.7 ± 9.1 (Site 2). Interviews identified key themes of "visibility" and providing a "quick snapshot" of patient data as the main positive attributes. Technology "functionality" was perceived negatively. Use of the data collection forms was minimal, with inconsistency across sites: (Site 3, 0% to Site 2, 47%). Negative themes of "inefficiency," poor "functionality" and the "trust" required in data entry practices were found.
Despite its user-centered design, clinicians did not always use the enhancement in line with its intended design, or grasp its intended value. Our findings highlight the challenges of user-centered design to accurately reflect clinical workflows within different contexts. A greater understanding is required of how to optimize user-centered EMR design for specific hospital contexts.
本研究旨在确定以用户为中心的电子病历（EMR）增强功能在中风护理中的使用情况和感知价值，并了解其价值是否与预期设计相符。该EMR增强功能已引入澳大利亚昆士兰州的公立医院，包括用于加强跨专业协作的摘要页面和用于高效数据提取的数据收集表。
采用混合方法设计，从四个医院站点收集数据。我们对参与站点的多学科最终用户进行了15次半结构化访谈，并使用归纳主题技术分析了这些数据。从EMR中提取使用日志数据以确定其使用情况。
摘要页面的相对使用情况显示使用程度适中，每月每位中风患者入院的使用次数从66±22.5次（站点1）到26.7±9.1次（站点2）不等。访谈确定了“可见性”和提供患者数据“快速快照”作为主要积极属性的关键主题。技术“功能”被认为是负面的。数据收集表的使用很少，各站点之间存在不一致：（站点3为0%，站点2为47%）。发现了“效率低下”、“功能”不佳以及数据录入操作中需要“信任”等负面主题。
尽管其设计以用户为中心，但临床医生并不总是按照预期设计使用该增强功能，也没有领会其预期价值。我们的研究结果凸显了以用户为中心的设计在准确反映不同背景下临床工作流程方面的挑战。需要更深入地了解如何针对特定医院背景优化以用户为中心的EMR设计。
