Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices
Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices
复制标题
DOI：
10.1007/s11606-009-1195-2
复制
发表时间：
2010-03-01
影响因子：
5.7
通讯作者：
Pham, Hoangmai H.
中科院分区：
文献类型：
--
作者：
O'Malley, Ann S.;Grossman, Joy M.;Pham, Hoangmai H.
背景技术背景：促进广泛采用电子医疗记录（EMR）的政策被认为是希望它们可以改善护理的协调。然而，很少有人知道医生的做法是否以及如何使用目前的电子病历，以促进coordination. Competitives：我们研究是否以及如何使用商业电子病历的做法，以支持协调任务，并确定变通办法的做法，创造了解决新的协调挑战。设计，设置：半结构化的电话采访中，随机选择的12个社区。参与者：60名受访者，包括52名医生或工作人员从26个做法与商业门诊医疗EMR到位至少2年，首席医疗官在四个EMR供应商，和四个国家的思想领袖。（1）电子病历促进了办公室内的护理协调，主要是通过在患者就诊期间提供数据访问和通过电子消息传递;（2）EMR不太能够支持临床医生和环境之间的协调，部分原因是它们设计和信息交换所需的关键数据元素缺乏标准化;（3）管理来自EMR的信息溢出对临床医生来说是一个挑战;（4）临床医生认为目前的EMR不能充分捕捉医疗决策过程和未来的护理计划以支持协调;（5）实现EMR促进协调的潜力需要实践操作过程的演变;（6）目前的按服务收费的报销鼓励电子病历用于记录可收费事件（办公室访问，程序）和不护理协调（这不是一项收费活动）。政策制定者的期望和临床从业人员的经验之间存在差距，目前的电子医疗记录支持护理协调的能力。决策者可以扩大目前的卫生信息技术政策，以支持评估技术如何促进协调所需的任务。通过改革支付政策以包括护理协调，政策制定者可以鼓励EMR技术的发展，包括支持协调的功能，例如，允许跨实践数据交换和多提供者临床决策支持。
BACKGROUND: Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.OBJECTIVES: We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges.DESIGN, SETTING: Semi-structured telephone interviews in 12 randomly selected communities.PARTICIPANTS: Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.RESULTS: Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).CONCLUSIONS: There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.