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电子病历对孕产妇保健的影响:一项范围综述。

The impact of electronic medical records on maternal healthcare: A scoping review.

作者信息

Kirwa Titus, Lobo Elton, Engstrom Teyl, Felix Terence, Vasudevan Abhinand, McDonald Nicole, Turner Lyle, Butler Lindsey, Reid Natasha, McPhail Steven, Ferris Jason, Sullivan Clair

机构信息

The University of Queensland, Queensland Digital Health Centre, Herston, QLD, Australia.

The University of Queensland, Queensland Digital Health Centre, Herston, QLD, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia; The University of Western Australia, School of Allied Health, Perth, WA, Australia.

出版信息

Int J Med Inform. 2025 Aug;200:105929. doi: 10.1016/j.ijmedinf.2025.105929. Epub 2025 Apr 14.

Abstract

BACKGROUND

Electronic medical records (EMRs) offer benefits in healthcare but also present challenges in maternity care. While EMRs have transformed healthcare and enhanced patient care and clinical research, their related tasks may disrupt woman-centred care and increase documentation burdens. However, there is insufficient evidence of the impact of EMRs on maternal healthcare.

OBJECTIVE

This scoping review identified contemporary implementation issues and outcomes guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Quintuple Aim for Healthcare Improvement frameworks.

METHODS

This scoping review identified studies from seven databases (MEDLINE, CINAHL, Embase, Scopus, Web of Science, IEEE Xplore, and ACM) published between 2019 and 2024 using search terms related to EMRs and maternal healthcare.

RESULTS

Thirteen studies on EMRs in maternity settings were included. EMRs positively affected maternal healthcare, as seen through RE-AIM and Quintuple Aim. However, limited attention is given to provider satisfaction, cost-effectiveness, and health equity. On the RE-AIM, studies frequently focused on health service setting-level outcomes with little attention to patient-level and provider-level outcomes. Key enablers of successful EMR implementation included stakeholder involvement, user training, and the willingness of healthcare providers to adapt. Challenges such as data quality issues, high initial costs, patient refusal, staffing complexities, alarm fatigue, and low EMR usage among maternity patients impacted the overall reach and effectiveness of the EMRs.

CONCLUSION

Future research should prioritise evaluating the impacts of EMRs through a comprehensive lens aligned with Quintuple Aim outcomes to ensure informed decision-making and enhance maternal healthcare practices.

摘要

背景

电子病历(EMR)在医疗保健中带来了诸多益处,但在产科护理中也带来了挑战。虽然电子病历已经改变了医疗保健方式,提升了患者护理和临床研究水平,但其相关任务可能会干扰以患者为中心的护理,并增加文档负担。然而,关于电子病历对孕产妇医疗保健影响的证据并不充分。

目的

本范围综述确定了以卫生保健改善框架中的“普及、效果、采用、实施和维持”(RE-AIM)以及“医疗保健改进五重目标”为指导的当代实施问题和结果。

方法

本范围综述通过使用与电子病历和孕产妇医疗保健相关的检索词,从2019年至2024年期间发表在七个数据库(MEDLINE、CINAHL、Embase、Scopus、科学网、IEEE Xplore和ACM)中的研究中进行筛选。

结果

纳入了13项关于产科环境中电子病历的研究。从RE-AIM和五重目标来看,电子病历对孕产妇医疗保健产生了积极影响。然而,对提供者满意度、成本效益和健康公平性的关注有限。在RE-AIM方面,研究通常侧重于卫生服务机构层面的结果,而对患者层面和提供者层面的结果关注较少。电子病历成功实施的关键推动因素包括利益相关者的参与、用户培训以及医疗保健提供者的适应意愿。数据质量问题、高昂的初始成本、患者拒绝、人员配置复杂、警报疲劳以及产科患者中电子病历使用率低等挑战影响了电子病历的整体普及程度和效果。

结论

未来的研究应优先通过与五重目标结果相一致的全面视角来评估电子病历的影响,以确保做出明智的决策并改善孕产妇医疗保健实践。

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