Burden Marisha, Keniston Angela, McBeth Lauren, Astik Gopi, Kangelaris Kirsten N, Kochar Aveena, Knees Michelle, Segon Ankur, Westergaard Sara, Yu Amy, Sakumoto Matthew, Chadha Romil
Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Hosp Med. 2025 Jul;20(7):677-687. doi: 10.1002/jhm.13572. Epub 2024 Dec 25.
Clinician electronic actions within the electronic health record (EHR) are captured seamlessly in real-time during regular work activities in all major EHRs. Analysis of this EHR use metadata, such as audit log data, is increasingly used to understand the impact of work design on critical patient, workforce, and organizational outcomes.
Understand experiences and perspectives influencing the use and implementation of audit log data into practice.
Mixed methods design utilizing focus groups and embedded survey with hospitalist group leaders attending a national society special interest group. Themes and subthemes were identified.
Seven semistructured virtual focus groups were held with 16 individuals from 16 different organizations on December 12, 2023, with a 100% survey response rate. Survey results highlighted the lack of familiarity with audit log data, the lack of tools and training for use, and the lack of established protocols to respond to insights, with some concerns for the accuracy of the data. Four themes and multiple subthemes were identified and included: (1) Limited, but widely variable use of audit log data driven by a lack of access, resources, skills, and knowledge, (2) mistrust and skepticism about the data, including concerns about potential misuse and a lack of best practices and standards, (3) perspectives around audit log data are culture and context driven, and (4) excitement for the many potential use cases.
Despite all major EHRs having audit log data, participants had limited access, training, and knowledge. Although there was mistrust, many opportunities were identified.
在所有主流电子健康记录（EHR）中，临床医生在日常工作活动期间会实时无缝捕获EHR中的电子操作。对诸如审计日志数据等EHR使用元数据的分析越来越多地用于了解工作设计对关键患者、劳动力和组织成果的影响。
了解影响审计日志数据在实践中使用和实施的经验和观点。
采用混合方法设计，利用焦点小组和对参加全国性学会特别兴趣小组的住院医师组长进行嵌入式调查。确定了主题和子主题。
2023年12月12日，与来自16个不同组织的16个人进行了7次半结构化虚拟焦点小组讨论，调查回复率为100%。调查结果突出显示了对审计日志数据缺乏熟悉度、缺乏使用工具和培训，以及缺乏应对见解的既定协议，同时对数据的准确性也存在一些担忧。确定了四个主题和多个子主题，包括：（1）由于缺乏访问权限、资源、技能和知识，审计日志数据的使用有限但差异很大；（2）对数据的不信任和怀疑，包括对潜在滥用的担忧以及缺乏最佳实践和标准；（3）围绕审计日志数据的观点受文化和背景驱动；（4）对众多潜在用例感到兴奋。
尽管所有主流EHR都有审计日志数据，但参与者的访问权限、培训和知识有限。虽然存在不信任，但也发现了许多机会。
