Sharing data from electronic health records within, across, and beyond healthcare institutions: Current trends and perspectives
Sharing data from electronic health records within, across, and beyond healthcare institutions: Current trends and perspectives
复制标题
在医疗机构内部、内部和外部共享电子健康记录的数据：当前趋势和观点
DOI：
10.1093/jamia/ocy116
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
L. Ohno
中科院分区：
文献类型：
--
作者：
L. Ohno
本期 JAMIA 重点关注电子健康记录 (EHR) 的各种用途，为个人提供更好的护理并协助机构内部和跨机构的护理人员。 EHR 长期以来一直用于临床决策支持 (CDSS)，但其在美国的广泛采用只是在过去十年中实现的。从那时起，一些基于电子病历数据的信息学研究随之而来。在本期 JAMIA 中，我们介绍了与使用 CDSS 改善患者护理相关的文章。 Grundmeier (p. 1160) 评估了部位感染的预测模型，Sperl-Hillen (p. 1137) 报告了一项 CDSS 降低心血管风险的随机试验，Cheung (p. 1202) 展示了在主要学术医疗中心实施 CDSS 后如何降低特定心血管疾病的风险，Slight (p. 1183) 展示了 CDSS 如何通过避免与以下疾病相关的不良事件的形式来提高安全性： Ramirez（第 1167 页）描述了用于糖尿病药物剂量调整的 CDSS，最后 Gamble（第 1240 页）以机器可读格式系统地审查了可用性和临床药物信息覆盖范围，否则 CDSS 的实施是不切实际的。电子病历还可以用于以其他方式改善患者护理。 Mummadi（第 1228 页）报告了使用计算机订单输入系统向临床医生显示价格信息的效果，而 Laranjo（第 1248 页）则系统地审查了医疗保健中的会话代理。对 EHR 使用透明度的日益增长的需求也可以解释 Fossa 所描述的 OpenNotes 越来越多的采用（第 1153 页）。虽然 EHR 被广泛采用并在支持医疗保健决策和安全方面发挥着重要作用，但值得注意的是，EHR 并不是高度分散且成本效益较低的医疗保健系统的灵丹妙药：Krumholtz（第 1218 页）提供了 EHR 使患者受益的前景，Ratwani（第 1197 页）评估了 EHR 系统的可用性和安全性，Gilmore-Bykovski（第 1206 页）解决了 EHR 系统缺乏结构的问题。认知和行为功能障碍的临床记录。 Holmgren 报告了院内共享 EHR 信息与卫生系统组织结构之间的关联（第 1147 页）。本期 JAMIA 还包括有关医疗机构之间共享健康信息的研究。 Menachemi (p. 1259) 和 Everson (p. 1114) 分别描述了跨机构健康信息交换 (HIE) 的好处和差距。 Vest (p. 1189) 报告称，医院内 HIE 的采用与医院间 HIE 呈负相关。 Beskow（第 1122 页）描述了患者对使用 EHR 的看法，这导致研究人员与他们联系。重要的是要了解，EHR 并不是影响患者护理的唯一健康数据来源：本期 JAMIA 提供了弗里德曼 (p. 1130)、Bumham (p. 1221)、McCulloh (p. 1175) 和 Gurbeta (p. 1213) 分别报道的在线支持小组、可穿戴技术、基于移动的儿科临床决策支持和远程医疗的影响示例。我们在这里展示的文章是我们领域多样性的主要例子，以及信息学可以帮助促进健康和减轻疾病的许多实用方法。与此同时，重要的是我们尝试其他在不久的将来将成为主流的新颖应用程序。请继续关注十月号，我们将重点关注临床和转化研究信息学。
This issue of JAMIA focuses on various uses of electronic health records (EHRs) to provide better care for individuals and assist caregivers within and across institutions. EHRs have been used for clinical decision support (CDSS) for a long time, but their wide adoption in the United States was achieved only in the past decade. Several informatics studies based on EHR data have followed since then. In this issue of JAMIA, we present articles related to the use of CDSS to improve patient care. Grundmeier (p. 1160) evaluates a predictive model for site infections, Sperl-Hillen (p. 1137) reports on a randomized trial of a CDSS to reduce cardiovascular risk, Cheung (p. 1202) shows how the risk for a specific cardiovascular condition was reduced in a major academic medical center upon implementation of a CDSS, Slight (p. 1183) shows how a CDSS can promote safety in the form of aversion of adverse events related to medications, Ramirez (p. 1167) describes a CDSS for diabetes medication dose adjustments, and finally Gamble (p. 1240) systematically reviews availability and clinical drug information coverage in machine-readable format, without which the implementation of CDSS is not practical. EHRs can be utilized to improve patient care in other ways as well. Mummadi (p. 1228) reports on the effect of displaying price information to clinicians using a computerized order entry system, while Laranjo (p. 1248) systematically reviews conversational agents in healthcare. An increasing demand towards transparency of EHR usage can also explain the increasing adoption of OpenNotes described by Fossa (p. 1153). While widely adopted and playing important roles in supporting decision making and safety in healthcare, it is important to note that EHRs are not a panacea for a highly fragmented and somewhat cost-ineffective healthcare system: Krumholtz (p. 1218) provides a perspective on the promise of EHRs to benefit patients, Ratwani (p. 1197) assesses usability and safety of EHR systems, and Gilmore-Bykovski (p. 1206) addresses the lack of structure in clinical documentation of cognitive and behavior dysfunctions. The association of intra-hospital sharing of EHR information and health system organizational structure is reported by Holmgren (p. 1147). This issue of JAMIA also includes studies on the sharing of health information across healthcare institutions. The benefits and gaps of health information exchange (HIE) across institutions are described by Menachemi (p. 1259) and Everson (p. 1114), respectively. Vest (p. 1189) reports that adoption of intra-hospital HIE is negatively associated with inter-hospital HIE. Beskow (p. 1122) describes patients’ perspectives on the use of EHRs that results in their being contacted by researchers. It is important to understand that an EHR is not the only source of health data that can impact a patient’s care: this issue of JAMIA provides examples of the impact of online support groups, wearable technology, mobile-based pediatric clinical decision support, and telehealth as reported by Friedman (p. 1130), Bumham (p. 1221), McCulloh (p. 1175), and Gurbeta (p. 1213), respectively. The articles we present here are prime examples of the diversity of our field and the many practical ways in which informatics can help promote health and mitigate disease. At the same time, it is important that we experiment with other novel applications that will be mainstream in the near future. Stay tuned for the October issue in which we focus on clinical and translational research informatics.