Weir C, Lincoln M, Roscoe D, Turner C, Moreshead G
Salt Lake City Veteran's Affair Information Systems Center, Utah.
Proc Annu Symp Comput Appl Med Care. 1994:653-7.
Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.
实施综合电子病历需要医生直接录入医嘱。此应用涉及整个医疗系统的多层次变革，从医生态度到部门间关系。本研究报告了改良德尔菲法第一轮的结果，该方法邀请了不同群体的个人来确定与医嘱录入应用实施相关的最重要的促进因素和阻碍因素。通过对他们回答的Q分类法，我们确定了20个被认为是成功实施的因果因素的系统、行为和态度维度。我们还通过比较成功医院和不成功医院中受访者提及这些维度的频率差异，探讨了这些维度如何影响成功。我们发现，尽管所有参与者最常提到的因素是现有功能，但成功医院比不太成功的医院更常提到硬件可用性、医生参与度、行政支持和医疗管理参与度。这些结果表明，不太成功的医院不存在这些因素。我们还发现，每个类别中的回答频率因回答者的机构角色而异。参与支持工作的人往往比临床岗位的人更看重组织变量，而临床医生则认为行政支持和院长的参与更为重要。这些发现支持了这样一种观点，即建立医生医嘱录入系统所涉及的变革是全系统范围的，涉及个人和组织因素。
