Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs
Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs
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DOI：
10.1093/jamia/ocv066
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发表时间：
2015-09-01
影响因子：
6.4
通讯作者：
Zaroukian, Michael H.
中科院分区：
文献类型：
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作者：
Payne, Thomas H.;Corley, Sarah;Zaroukian, Michael H.
过去 5 年，在不断变化的医疗保健环境以及经济和临床健康健康信息技术 (HITECH) 有意义使用 (MU) 电子健康记录 (EHR) 激励计划的刺激下，EHR 的采用显着增加，并且有早期证据表明这种采用带来了医疗保健安全和质量效益。 1, 2 然而，随着这种广泛采用，许多临床医生担心 EHR 的使用会产生意想不到的临床后果，包括减少患者与临床医生互动的时间、将 3 个新的繁重数据输入任务转移给一线临床医生、4、5 以及延长临床医生工作日。 6-8 此外，尽管为实现这一目标付出了巨大努力，但不同 EHR 系统之间的互操作性仍处于疲软状态。 9, 10 这些挑战导致医生对工作生活的满意度下降。 11-13 在专业期刊、14 篇新闻报道、15-17 在病房和诊所中，我们听说了从纸质记录过渡到电子病历所带来的困难。 18 因此，临床医生正在寻求帮助来度过工作日，而这些工作日往往会延长到晚上专门写笔记。我们从临床医生和患者那里收到的评论示例包括：“计算机总是让事情变得更快、更便宜。但这次不是”，以及“我的医生对计算机的关注比对我的关注更多。”医疗保健系统的最终目标是创建一个强大、集成且可互操作的医疗保健系统，其中包括患者、医生实践、公共卫生、人口管理以及对临床和基础科学研究的支持。这个生态系统被称为“学习健康系统”。 19 EHR 与许多其他临床系统一样，是学习健康系统的重要组成部分，但未来将信息转化为知识的方式可能需要系统的所有部分协同工作。潜在的每一次患者接触都可能为患者和临床医生提供一个机会，帮助我们加深对医疗保健的理解并参与研究和临床试验。作为学习健康系统的一部分，电子病历长期以来一直被认为有利于医疗保健的安全和质量，并且研究表明，与信息可访问性、决策支持、用药安全、测试结果管理和许多其他领域相关的潜在好处。 20, 21 然而，任何新技术的实施都会带来新的风险和意想不到的后果；这些也都有详细记录。 22-24过去十年，MU 和其他激励措施的主要重点是鼓励提供者和其他卫生专业人员实施 EHR 并使用它们来捕获和共享重要的质量和成本数据。现在的工作包括确保这些系统的设计和实施能够产生所承诺的结果
Over the last 5 years, stimulated by the changing healthcare environment and the Health Information Technology for Economic and Clinical Health (HITECH) Meaningful Use (MU) Electronic Health Record (EHR) Incentive program, EHR adoption has increased remarkably, and there is early evidence that such adoption has resulted in healthcare safety and quality benefits. 1, 2 However, with this broad adoption, many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction, 3 new and burdensome data entry tasks being transferred to front-line clinicians, 4, 5 and lengthened clinician workdays. 6–8 Additionally, interoperability between different EHR systems has languished despite large efforts towards that goal. 9, 10 These challenges are contributing to physicians’ decreased satisfaction with their work lives. 11–13 In professional journals, 14 press reports, 15–17 on wards, and in clinics, we have heard of the difficulties that the transition from paper records to EHRs has created. 18 As a result, clinicians are seeking help to get through their work days, which often extend into evenings devoted to writing notes. Examples of comments we have received from clinicians and patients include:“Computers always make things faster and cheaper. Not this time,” and “My doctor pays more attention to the computer than to me.” Ultimately the healthcare system’s goal is to create a robust, integrated, and interoperable healthcare system that includes patients, physician practices, public health, population management, and support for clinical and basic sciences research. This ecosystem has been referred to as the “learning health system.” 19 EHRs are an important part of the learning health system, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the system working together. Potentially every patient encounter could present an opportunity for patients and clinicians alike to contribute to our understanding of healthcare and participate in research and clinical trials. As part of the learning health system, EHRs have long been touted as beneficial to the safety and quality of healthcare, and studies have shown potential benefits related to information accessibility, decision support, medication safety, test result management, and many other areas. 20, 21 However, implementation of any new technology leads to new risks and unintended consequences; these too have been welldocumented. 22–24Much of the focus of MU and other incentives over the past decade has been to encourage providers and other health professionals to implement EHRs and use them to capture and share important quality and cost data. The work now ahead involves ensuring that these systems are designed and implemented in a way that yields the promised