Kim Hana, Lee Jisan, Kim Sukwha, Kim Deok-Yeol
Department of Nursing, College of Life & Health Sciences, Hoseo University, Asan, Korea.
Department of Nursing, Gangneung-Wonju National University, Wonju, Korea.
Healthc Inform Res. 2024 Oct;30(4):333-343. doi: 10.4258/hir.2024.30.4.333. Epub 2024 Oct 31.
This study aimed to assess the feasibility of implementing OpenNotes in Korea. It involved developing and evaluating the Open-CHA service, which provides clinical summary information to patients diagnosed with craniofacial deformities and their caregivers following outpatient visits.
The study included 109 patients diagnosed with craniofacial deformities, along with their caregivers. The Open-CHA service was developed by referencing OpenNotes and involved a user needs assessment, a pilot test, and an evaluation of its effectiveness. Data were analyzed using descriptive statistics and the paired t-test.
Short message service templates for the Open-CHA service based on a user needs assessment conducted with patients, caregivers, and healthcare professionals. These templates were refined and improved following a pilot test. After the implementation of the Open-CHA service, most participants evaluated OpenNotes positively. Additionally, there were observed increases in health knowledge and efficacy in patient-physician interactions. A statistically significant improvement in mobile health literacy was also confirmed.
The implementation of the Open-CHA service significantly enhanced mobile health literacy among patients with craniofacial deformities and their caregivers, indicating positive outcomes for the potential adoption of OpenNotes in Korea. This suggests that introducing OpenNotes into the Korean healthcare system is appropriate.
本研究旨在评估在韩国实施开放病历（OpenNotes）的可行性。该研究包括开发和评估开放颅面畸形患者护理服务（Open-CHA），该服务在门诊就诊后为被诊断患有颅面畸形的患者及其护理人员提供临床总结信息。
该研究纳入了109名被诊断患有颅面畸形的患者及其护理人员。Open-CHA服务是通过参考OpenNotes开发的，包括用户需求评估、试点测试及其有效性评估。使用描述性统计和配对t检验对数据进行分析。
基于对患者、护理人员和医疗专业人员进行的用户需求评估，制定了Open-CHA服务的短信服务模板。经过试点测试后，这些模板得到了完善和改进。在实施Open-CHA服务后，大多数参与者对开放病历给予了积极评价。此外，还观察到患者的健康知识有所增加，医患互动效果有所提高。移动健康素养也有统计学意义的显著提高。
Open-CHA服务的实施显著提高了颅面畸形患者及其护理人员的移动健康素养，表明在韩国采用开放病历可能会有积极成果。这表明将开放病历引入韩国医疗系统是合适的。
