Family Physicians' Perceptions and Use of Electronic Clinical Decision Support During the First Year of Implementation
Family Physicians' Perceptions and Use of Electronic Clinical Decision Support During the First Year of Implementation
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DOI：
10.1007/s10916-012-9841-3
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发表时间：
2012-12-01
影响因子：
5.3
通讯作者：
Ramaekers, Dirk
中科院分区：
文献类型：
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作者：
Heselmans, Annemie;Aertgeerts, Bert;Ramaekers, Dirk
电子决策支持系统（EBMeDS 系统）已集成到比利时家庭医生的电子病历 (EMR) 中（2010 年 2 月）。用户对系统的接受被认为是任何IT项目有效实施的必要条件。为了成功实施，需要理解促进因素、障碍和不接受问题，并尽量减少意外的采用行为。该研究的目的是评估用户对最近实施的 EBMeDS 系统的看法、调查用户与系统的交互以及看法和使用之间可能的关系。进行了由定性和定量分析组成的混合评估方法。 UTAUT 的技术接受模型被用作开发问卷的结构模型，以确定可能影响 EBMeDS 系统接受和使用的因素（七点李克特量表）。对计算机记录的用户与系统的交互进行了为期 3 个月的评估期的定量分析，以评估系统的实际使用情况。定性和定量分析是相互联系的。 39 名家庭医生 (12%) 完成了调查。大多数受访者（66%）总体上对该系统持积极态度。继续使用该系统的平均意愿很高 (5.91 +/- 1.33)。他们对系统的易用性（平均 5.04 +/- 1.41）、实用性（平均 4.69 +/- 1.35）和便利条件（4.43 +/- 1.13）的看法总体上是积极的。只有 0.35% 的提醒是按需请求的，其他 99.62% 的提醒是自动显示的。 0.47% 的自动显示提醒需要详细指南（长），而 16.17% 的按需提醒则需要。自动显示的提醒中有 8.4% 需要使用提醒背后的脚本，而按需显示的提醒中只有 13.6% 需要使用提醒脚本。大多数受访者对 EBMeDS 系统的接受程度较高。尽管大多数受访者总体上对系统的易用性、实用性和便利条件持积极态度，但部分陈述给出的结果相当复杂，可以被确定为未来实施举措和系统改进的重要关注点。必须强调的是，我们的人口由愿意回答调查问卷的早期采用者的方便样本组成。是否愿意采用该系统取决于是否愿意使用ICPC编码。因此，提醒的质量部分取决于编码的质量。需要接触更多的医生（包括从未使用过该系统或停止使用该系统的医生）来验证本次调查的结果。
An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users' perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 +/- 1,33). Their perception of the ease of use of the system (mean 5,04 +/- 1,41), usefulness (mean 4,69 +/- 1,35) and facilitating conditions (4,43 +/- 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.