Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use.
Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use.
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DOI：
10.1136/amiajnl-2011-000432
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发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Lorenzi NM
中科院分区：
文献类型：
--
作者：
Unertl KM;Johnson KB;Lorenzi NM
本研究的目的是深入了解健康信息交换（HIE）如何适应多个临床站点的临床工作流程。在美国田纳西州孟菲斯的6个急诊科（艾德）和8个门诊诊所进行了为期9个月的人种学定性研究。数据收集使用直接观察，观察期间的非正式访谈，正式的半结构化访谈。作者观察了超过180小时，在此期间，提供商使用交换130次。 对每个艾德研究中心和门诊组的HIE相关工作流程进行建模，并确定了研究中心间工作流程的实质性差异。还在所有研究中心确定了HIE相关工作流程的常见模式，从而开发了两种基于角色的工作流程模型：基于护士和基于医生。将工作流元素框架应用于这两种基于角色的模式。深入描述了提供者如何将新生儿缺氧缺血性脑病整合到现有的临床工作流程中，包括新生儿缺氧缺血性脑病使用提示。工作流程差异很大的网站，但两个一般的基于角色的HIE的使用模式被确定。虽然供应商使用HIE，以提高病人护理的连续性，病人-供应商的信任发挥了重要作用。检索到的信息类型与角色有关，护士寻求检索最近的住院数据，护士执业者和医生的使用更加开放。用户和角色特定的定制，以适应不同的工作流程和信息需求可能会增加HIE的采用和使用。了解最终用户对HIE技术的看法对HIE的长期成功至关重要。通过应用定性方法，深入了解HIE的使用。
The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into clinical workflow at multiple clinical sites. The ethnographic qualitative study was conducted over a 9-month period in six emergency departments (ED) and eight ambulatory clinics in Memphis, Tennessee, USA. Data were collected using direct observation, informal interviews during observation, and formal semi-structured interviews. The authors observed for over 180 h, during which providers used the exchange 130 times. HIE-related workflow was modeled for each ED site and ambulatory clinic group and substantial site-to-site workflow differences were identified. Common patterns in HIE-related workflow were also identified across all sites, leading to the development of two role-based workflow models: nurse based and physician based. The workflow elements framework was applied to the two role-based patterns. An in-depth description was developed of how providers integrated HIE into existing clinical workflow, including prompts for HIE use. Workflow differed substantially among sites, but two general role-based HIE usage models were identified. Although providers used HIE to improve continuity of patient care, patient–provider trust played a significant role. Types of information retrieved related to roles, with nurses seeking to retrieve recent hospitalization data and more open-ended usage by nurse practitioners and physicians. User and role-specific customization to accommodate differences in workflow and information needs may increase the adoption and use of HIE. Understanding end users' perspectives towards HIE technology is crucial to the long-term success of HIE. By applying qualitative methods, an in-depth understanding of HIE usage was developed.
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DOI：
10.1016/j.ijmedinf.2010.11.008
发表时间：
2011-03-01
影响因子：
4.9
作者：
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影响因子：
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发表时间：
2010-05-01
影响因子：
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发表时间：
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影响因子：
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DOI：
10.1197/jamia.m3000
发表时间：
2009-11-01
影响因子：
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作者：
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