Assessment of Electronic Health Record Search Patterns and Practices by Practitioners in a Large Integrated Health Care System
Assessment of Electronic Health Record Search Patterns and Practices by Practitioners in a Large Integrated Health Care System
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DOI：
10.1001/jamanetworkopen.2020.0512
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发表时间：
2020-03-06
影响因子：
13.8
通讯作者：
Liu, Vincent X.
中科院分区：
文献类型：
--
作者：
Ruppel, Halley;Bhardwaj, Aashish;Liu, Vincent X.
电子健康记录（EHR）是从业者不满的一个来源，部分原因是信息检索的挑战。为了提高数据的可访问性，需要更好地了解医生在个人病历中的信息需求。目的利用大型综合医疗保健系统的数据评估电子健康记录用户的搜索情况。设计、设置和参与者这项回顾性横断面分析使用来自Kaiser Permanente北方加州的EHR检索数据，Kaiser Permanente是一个拥有440多万成员的综合医疗保健提供系统。用户的EHR搜索活动数据是从2018年4月1日到2019年5月15日获得的。主要结果和测量检索词频率按用户和从业者类型分组。网络分析进行了一个单一的搜索事件内的共现搜索词，并计算搜索词的中心性措施（度和介数中心性）。结果在977 & x202 f;160个独特的患者EHR中，共有34 & x202 f;735个独特的用户进行了12 & x202 f;313 & x202 f;047次搜索活动（包括4 & x202 f;328 & x202 f;330次搜索和7 & x202 f;984 & x202 f;717次结果查看）。总的来说，用户搜索了208&x202f;374个独特的搜索词，并进行了4次搜索的中位数（四分位数范围，1-28次搜索）。在所有97 & x202 f;367活跃的EHR用户中，34 & x202 f;735（35.7%）进行了至少一次搜索。然而，在所有12968名活跃的EHR医生用户中，9801名（75.6%）至少进行了一次搜索，在所有1908名活跃的药剂师用户中，1402名（73.5%）至少进行了一次搜索。最常搜索的前三个词是他汀类药物（75 & x202 f;017次搜索[1.7%]），结肠镜检查（73 & x202 f;545 [1.7%]）和PFT（54 & x202 f;990 [1.3%]）。然而，在不同的从业者群体中，顶级搜索的差异很大。在单个链接检索事件中，最常与另一个术语一起检索的术语包括他汀类药物、赖诺普利、结肠镜检查、加巴喷丁和阿司匹林。结论和相关性虽然医生和药剂师是EHR搜索的最活跃用户，但搜索量和经常搜索的术语因用户角色而异。EHR界面的进一步定制可能有助于利用用户的搜索内容和模式，以提高有针对性的信息retrieval.This横断面研究使用的数据从一个大型综合医疗保健系统，以评估搜索模式和电子健康记录用户之间的做法。结果在这项横断面研究的12 &x202f;313 &x202f;047患者电子健康记录搜索活动，医生和药剂师进行了最多的搜索，与他汀类药物，结肠镜检查，和PFT是最常见的搜索条件。检索词网络揭示了用户如何将与单个临床交互相关的各个领域的数据桥接在一起。意义我们的研究结果表明，存在的机会，通过确定潜在的领域来定制基于不同的用户角色和链接的搜索方法的信息检索，以提高电子健康记录的临床使用。
Importance The electronic health record (EHR) is a source of practitioner dissatisfaction in part because of challenges with information retrieval. To improve data accessibility, a better understanding of practitioners' information needs within individual patient records is needed. Objective To assess EHR users' searches using data from a large integrated health care system. Design, Setting, and Participants This retrospective cross-sectional analysis used EHR search data from Kaiser Permanente Northern California, an integrated health care delivery system with more than 4.4 million members. Users' EHR search activity data were obtained from April 1, 2018, to May 15, 2019. Main Outcomes and Measures Search term frequency was grouped by user and practitioner types. Network analyses were performed of co-occurring search terms within a single search episode, and centrality measures for search terms (degree and betweenness centrality) were calculated. Results A total of 12 & x202f;313 & x202f;047 search activities (including 4 & x202f;328 & x202f;330 searches and 7 & x202f;984 & x202f;717 result views) conducted by 34 & x202f;735 unique users within 977 & x202f;160 unique patient EHRs were identified. In aggregate, users searched for 208 & x202f;374 unique search terms and conducted a median of 4 searches (interquartile range, 1-28 searches). Of all 97 & x202f;367 active EHR users, 34 & x202f;735 (35.7%) conducted at least 1 search. However, of all 12 & x202f;968 active EHR physician users, 9801 (75.6%) conducted at least 1 search, and of all 1908 active pharmacist users, 1402 (73.5%) conducted at least 1 search. The top 3 most commonly searched terms were statin (75 & x202f;017 searches [1.7%]), colonoscopy (73 & x202f;545 [1.7%]), and pft (54 & x202f;990 [1.3%]). However, wide variation in top searches were noted across practitioner groups. Terms searched most often with another term in a single linked search episode included statin, lisinopril, colonoscopy, gabapentin, and aspirin. Conclusions and Relevance Although physicians and pharmacists were the most active users of EHR searches, search volume and frequently searched terms varied considerably by and within user role. Further customization of the EHR interface may help leverage users' search content and patterns to improve targeted information retrieval.This cross-sectional study uses data from a large integrated health care system to assess search patterns and practices among electronic health record users.Question What are the electronic health record search patterns and practices among electronic health record users? Findings In this cross-sectional study of 12 & x202f;313 & x202f;047 patient electronic health record search activities, physicians and pharmacists conducted the most searches, with statin, colonoscopy, and pft being the most frequently searched terms. Search term networks revealed how users bridged together data across various domains relevant to a single clinical interaction. Meaning Our results suggest that opportunities exist for improving the clinical use of the electronic health record by identifying potential areas to customize information retrieval based on diverse user roles and linked search approaches.