A typology of electronic health record workarounds in small-to-medium size primary care practices
A typology of electronic health record workarounds in small-to-medium size primary care practices
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DOI：
10.1136/amiajnl-2013-001686
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发表时间：
2014-02-01
影响因子：
6.4
通讯作者：
Cohen, Deborah J.
中科院分区：
文献类型：
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作者：
Friedman, Asia;Crosson, Jesse C.;Cohen, Deborah J.
目的电子病历（EHR）在门诊医疗中的应用可提高安全性和质量；然而，设计、实现的问题以及与其他系统的不良接口导致用户开发“变通方法”，或者用户采用的行为来克服技术系统中的感知限制。我们记录了在独立的、以社区为基础的初级保健实践中使用的变通方法，并开发了其关键特征的类型学。材料与方法电子病历在7个独立的初级保健实践中的应用比较案例研究。现场研究人员在每个实践中花费了大约1个月的时间来观察电子病历的使用，指导患者路径，并采访临床医生和工作人员。结果：我们观察到解决各种ehr相关问题的变通方法，包括：用户界面问题（例如，数据字段不足，模板有限），与外部组织进行电子健康信息交换的障碍，以及将新技术纳入现有办公空间的困难。我们归纳分析了观察到的变通方法，以开发一种跨越特定临床或管理流程的类型，以突出一般变通方法的以下关键正式特征：临时/常规化，它捕获了变通方法是理所当然地作为日常工作流程的一部分还是被理解为短期解决方案；可避免/不可避免，指的是该变通方法在实践能力范围内能够消除的程度；以及有意选择的/计划外的，这区别于策略性选择的适应和不那么深思熟虑的变通。这种变通类型为EHR用户在自己的实践中识别和解决变通提供了一个框架，并为研究人员检查不同类型的EHR变通对患者安全、护理质量和效率的影响。
Objective Electronic health record (EHR) use in ambulatory care can improve safety and quality; however, problems with design, implementation, and poor interface with other systems lead users to develop 'workarounds', or behaviors users adopt to overcome perceived limitations in a technical system. We documented workarounds used in independent, community-based primary care practices, and developed a typology of their key features.Materials and methods Comparative case study of EHR use in seven independent primary care practices. Field researchers spent approximately 1 month in each practice to observe EHR use, conduct patient pathways, and interview clinicians and staff.Results We observed workarounds addressing a wide range of EHR-related problems, including: user interface issues (eg, insufficient data fields, limited templates), barriers to electronic health information exchange with external organizations, and struggles incorporating new technologies into existing office space. We analyzed the observed workarounds inductively to develop a typology that cuts across specific clinical or administrative processes to highlight the following key formal features of workarounds in general: temporary/routinized, which captures whether the workaround is taken for granted as part of daily workflow or is understood as a short-term solution; avoidable/unavoidable, referring to the extent to which the workaround is within the practice's power to eliminate; and deliberately chosen/unplanned, which differentiates strategically chosen adaptations from less thoughtful workarounds.Conclusions This workaround typology provides a framework for EHR users to identify and address workarounds in their own practices, and for researchers to examine the effect of different types of EHR workarounds on patient safety, care quality, and efficiency.