Rapid assessment of clinical information systems in the healthcare setting: an efficient method for time-pressed evaluation.
Rapid assessment of clinical information systems in the healthcare setting: an efficient method for time-pressed evaluation.
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DOI：
10.3414/me10-01-0042
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发表时间：
2011
影响因子：
1.7
通讯作者：
Wright A
中科院分区：
文献类型：
--
作者：
McMullen CK;Ash JS;Sittig DF;Bunce A;Guappone K;Dykstra R;Carpenter J;Richardson J;Wright A
美国最近的立法为实施电子健康记录(EHR)提供了强有力的激励措施。随之而来的美国医疗保健变革将增加对评估临床信息学干预措施的新方法的需求。时间线的限制和快速变化的环境将使传统的评估技术变得繁重。本文描述了一种人类学方法，它提供了一种快速而灵活的方法来评估临床信息系统。采用人类学的混合方法评估方法，我们描述了一种快速评估程序(RAP)，用于评估医疗保健中的临床信息学干预措施，我们在对美国不同的社区医院和初级保健机构进行了七次现场访问时开发并使用了该程序。我们的多学科团队使用RAP来评估鼓励人们使用临床决策支持(CDS)系统或干扰这些系统在从大型城市医院到小城镇的单一从业者和私人家庭诊所的环境中使用的因素。该方法的关键要素包括：1)制定实地工作指南；2)仔细选择观察地点和参与者；3)为实地访问做好充分准备；4)与当地合作者合作；5)使用多种研究人员和方法收集可靠的数据；6)以有助于评估组织的结构化方式分析和报告数据。RAP在访问美国七个临床站点的过程中迭代开发，成功地允许信息学研究人员的多学科团队以最高效率的方式规划、收集和分析数据并报告结果。
Recent legislation in the United States provides strong incentives for implementation of electronic health records (EHRs). The ensuing transformation in U.S. health care, will increase demand for new methods to evaluate clinical informatics interventions. Timeline constraints and a rapidly changing environment will make traditional evaluation techniques burdensome. This paper describes an anthropological approach that provides a fast and flexible way to evaluate clinical information systems. Adapting mixed-method evaluation approaches from anthropology, we describe a rapid assessment process (RAP) for assessing clinical informatics interventions in health care that we developed and used during seven site visits to diverse community hospitals and primary care settings in the United States.. Our multi-disciplinary team used RAP to evaluate factors that either encouraged people to use clinical decision support (CDS) systems, or interfered with use of these systems in settings ranging from large urban hospitals to single-practitioner, private family practices in small towns. Critical elements of the method include: 1) developing a fieldwork guide; 2) carefully selecting observation sites and participants; 3) thoroughly preparing for site visits; 4) partnering with local collaborators; 5) collecting robust data by using multiple researchers and methods; and 6) analyzing and reporting data in a structured manner helpful to the oraganizations being evluated. RAP, iteratively developed over the course of visits to seven clinical sites across the U.S., has succeeded in allowing a multidisciplinary team of informatics researchers to plan, gather and analyze data, and report results in a maximally efficient manner.