A Rheumatology-Specific Informatics-Based Application With a Disease Activity Calculator
A Rheumatology-Specific Informatics-Based Application With a Disease Activity Calculator
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DOI：
10.1002/art.24345
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发表时间：
2009-04-15
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影响因子：
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通讯作者：
Grant, Richard W.
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文献类型：
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作者：
Collier, Deborah S.;Kay, Jonathan;Grant, Richard W.
Objective.设计一个流变学专用工具，将疾病活动计算器集成到我们机构的电子病历（EMR）中，并评估医生对使用该工具的态度。流变学OnCall（ROC）应用程序从我们机构的实验室、微生物学、病理学、放射学和药学信息系统中挑选流变学相关数据。在临床检查时，参与的风湿病学家和风湿病研究员在门诊访问期间访问了ROC和疾病活动度计算器。在为期12周的研究期间，15名医生分别在474次和429次门诊就诊中使用ROC应用程序和疾病活动计算器。在每周的调查回复中，医生报告说，在179次访视中，ROC界面的使用改善了140次（78%）的患者护理，并且在访视时，28个关节的疾病活动评分（DAS 28）结果不会改变其中157次（88%）的患者管理。尽管在156次访视中的149次（96%）中观察到DAS 28的趋势是有用的。在研究结束时，大多数医生报告说ROC应用程序是有用的（12名医生中的11名），并且看到DAS 28的趋势改善了患者的日常护理（13名医生中的12名）。ROC应用程序在日常风湿病护理中很有用，疾病活动度计算器有助于类风湿关节炎患者的管理。然而，这些工具的广泛接受和使用取决于临床环境中对电子病历的普遍接受和访问。疾病活动性计算器的效用可能受到临床遭遇时缺乏可用急性期反应物结果的限制。
Objective. To design a rheumatology-specific tool with a disease activity calculator integrated into the electronic medical records (EMRs) at our institution and assess physicians' attitudes toward the use of this tool.Methods. The Rheumatology OnCall (ROC) application culls rheumatology-pertinent data from our institution's laboratory, microbiology, pathology, radiology, and pharmacy information systems. Attending rheumatologists and rheumatology fellows accessed the ROC and disease activity calculator during outpatient visits at the time of the clinical encounter.Results. During the 12-week study period, 15 physicians used the ROC application and the disease activity calculator during 474 and 429 outpatient clinic visits, respectively. In weekly survey responses, physicians reported that use of the ROC interface improved patient care in 140 (78%) of 179 visits, and that the Disease Activity Score in 28 joints (DAS28) results at the time of the visit would not have changed patient management in 157 (88%) of these, although seeing a trend in DAS28 was useful in 149 (96%) of 156 visits. At the study's conclusion, most physicians reported that the ROC application was useful (11 of 12 physicians) and that seeing a trend in DAS28 improved daily patient care (12 of 13 physicians).Conclusion. The ROC application is useful in daily rheumatologic care, and the disease activity calculator facilitates management of patients with rheumatoid arthritis. However, widespread acceptance and use of such tools depend upon the general acceptance of and access to EMRs in the clinical setting. The utility of the disease activity calculator may be limited by the lack of available acute-phase reactant results at the time of the clinical encounter.