Elson R B, Connelly D P
Department of Family Practice and Community Health, University of Minnesota, Minneapolis, USA.
Arch Fam Med. 1995 Aug;4(8):698-705. doi: 10.1001/archfami.4.8.698.
Implementation of practice guidelines remains problematic in spite of enormous efforts to develop and disseminate them, to establish their credibility, and to create incentives for physicians to adopt them. These strategies have failed to systematically change physician behavior because they do not address the involuntary time and mental processing constraints that have been clearly demonstrated to hamper physicians' ability to comply with guidelines. Computerized patient record systems directly address these constraints, and evidence is mounting that they are effective tools for changing physician behavior. A properly configured computerized patient record system provides decision support, facilitates work flow, and enables the routine collection of data for performance feedback. A synthesis of relevant research from the domains of practice guidelines and medical informatics strongly suggests that the operational support provided by computerized patient record systems will have a major impact on physician compliance with practice guidelines.
尽管人们付出了巨大努力来制定和传播实践指南，确立其可信度，并为医生采用这些指南创造激励措施，但实践指南的实施仍然存在问题。这些策略未能系统性地改变医生的行为，因为它们没有解决那些已被明确证明会妨碍医生遵守指南能力的非自愿时间和心理处理限制。计算机化患者记录系统直接解决了这些限制，并且越来越多的证据表明它们是改变医生行为的有效工具。一个配置得当的计算机化患者记录系统提供决策支持，促进工作流程，并能够常规收集数据以进行绩效反馈。来自实践指南和医学信息学领域的相关研究综合起来有力地表明，计算机化患者记录系统提供的操作支持将对医生遵守实践指南产生重大影响。
