User perspectives on an electronic decision-support tool performing comprehensive medication reviews - a focus group study with physicians and nurses.
User perspectives on an electronic decision-support tool performing comprehensive medication reviews - a focus group study with physicians and nurses.
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DOI：
10.1186/s12911-016-0245-z
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发表时间：
2016-01-22
影响因子：
3.5
通讯作者：
Liira H
中科院分区：
文献类型：
--
作者：
Koskela T;Sandström S;Mäkinen J;Liira H
虽然一些研究已经评估了计算机化的决策支持系统（CDSS）的有效性，有缺乏数据的用户的观点，障碍，并在现实生活中的环境中实施CDSS的促进者。本研究的目的是评估个人感知的障碍，促进者和影响CDSS的实施和可用性的想法。在这项定性研究中，五个焦点小组进行了医生和护士分别在坦佩雷市卫生中心，芬兰。与会者是EBMeDS计算机化决策支持系统的最终用户。采用探索性数据内容分析。从CDSS中获益的最重要障碍是缺乏结构化和编码的诊断文件以及电子健康记录中过时的药物信息。这导致了虚假警报和对系统的不信任。发现的主要促进因素包括，例如，帮助从业者考虑到否则会被忽视的事项的有益提醒;自动肾小球滤过率（GFR）计算;药物安全检查;以及单一药物审查中的摘要一目了然。医生和护士都热衷于使用CDSS，它可以加强他们的跨专业合作。以结构化、统一和简单的方式记录患者信息是电子决策支持的基本出发点。在实施CDSS时，管理人员需要关注组织中记录结构化数据的常见做法，以防止破坏对系统的信任。
Although a number of studies have evaluated the effectiveness of computerized decision-support systems (CDSS), there is lack of data on user perspectives, barriers, and facilitators to the implementation of CDSSs in real-life surroundings. The aim of this study was to assess individually perceived barriers, facilitators and ideas influencing the CDSS implementation and usability. In this qualitative study, five focus groups were carried out with physicians and nurses separately at the Tampere City Health Center, Finland. The participants were end-users of the EBMeDS computerized decision support system. An explorative data content analysis was applied. The most important barrier to benefitting from CDSS was the lack of structured and coded diagnosis documentation and outdated medication information in the electronic health records. This led to false alerts and distrust towards the system. Among the major facilitators found were e.g. the beneficial reminders that helped practitioners take into account matters otherwise ignored; automatic glomerular filtration rate (GFR) calculations; medication safety checks; and the summaries in the single medication review at a glance. Physicians’ and nurses’ are keen to use the CDSS and it may enhance their inter-professional collaboration. Documenting patient information in a structured, uniform and easy manner is the essential starting point for electronic decision support. When implementing CDSS, managers need to focus on common practices in documenting structured data in their organizations in order to prevent undermining trust in the system.