Safe use of the EHR by medical scribes: a qualitative study.
Safe use of the EHR by medical scribes: a qualitative study.
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DOI：
10.1093/jamia/ocaa199
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发表时间：
2021-02-15
期刊：
影响因子：
--
通讯作者：
Gold JA
中科院分区：
文献类型：
--
作者：
Ash JS;Corby S;Mohan V;Solberg N;Becton J;Bergstrom R;Orwoll B;Hoekstra C;Gold JA
雇用医疗抄写员代表提供者在电子健康记录（EHR）中记录可能会带来患者安全风险，因为抄写员通常没有接受过临床培训。本研究的目的是调查记录员对患者安全的影响。这包括确定最佳实践，以确保抄写员使用EHR不会对患者造成安全风险。使用社会技术框架和快速评估过程，我们进行了人种学数据收集在5个有目的地选择的网站。使用接地感应/解释方法分析数据。我们在2017年至2019年期间对美国5个组织的12家诊所和急诊室进行了实地访问。我们对81人进行了76次采访，花了80个小时观察抄写员与供应商的合作。受访者认为，观察表明，抄写员降低了患者的安全风险。数据分析产生了12个主题的4维社会技术框架内。关于“技术”方面的结果表明，电子健康记录并不被认为是过于有问题的抄写员或供应商。“环境”方面包括不断变化的抄写行业和对标准的需要。在“个人”方面，主题包括在使用抄写员时，提供者必须勤勉尽责和接受培训。最后，“组织”维度强调了抄写员对文档效率、质量和安全的积极影响。参与者认为与EHR相关的风险可以减少抄写员。如果医疗保健组织和抄写公司遵循最佳实践，如果提供者和抄写员接受培训，安全性实际上可以提高。
Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the “technical” dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The “environmental” dimension included the changing scribe industry and need for standards. Within the “personal” dimension, themes included the need for provider diligence and training when using scribes. Finally, the “organizational” dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.
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影响因子：
1.7
作者：
McMullen CK;Ash JS;Sittig DF;Bunce A;Guappone K;Dykstra R;Carpenter J;Richardson J;Wright A
通讯作者：
Wright A
影响因子：
2.1
作者：
Bank, Alan J.;Obetz, Christopher;Kenney, William O.
通讯作者：
Kenney, William O.
DOI：
10.1016/j.ijmedinf.2019.01.001
发表时间：
2019-03-01
影响因子：
4.9
作者：
Bossen, Claus;Chen, Yunan;Pine, Kathleen H.
通讯作者：
Pine, Kathleen H.
影响因子：
3.2
作者：
Pranaat, Robert;Mohan, Vishnu;Gold, Jeffrey A
通讯作者：
Gold, Jeffrey A
影响因子：
6.6
作者：
Koshy, Simi;Feustel, Paul J.;Kogan, Barry A.
通讯作者：
Kogan, Barry A.