A Multisite Survey Study of EMR Review Habits, Information Needs, and Display Preferences among Medical ICU Clinicians Evaluating New Patients
A Multisite Survey Study of EMR Review Habits, Information Needs, and Display Preferences among Medical ICU Clinicians Evaluating New Patients
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DOI：
10.4338/aci-2017-04-ra-0060
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Herasevich, Vitaly
中科院分区：
文献类型：
--
作者：
Nolan, Matthew E.;Cartin-Ceba, Rodrigo;Herasevich, Vitaly
目的重症监护病房（ICU）临床医生接收新患者的电子病历审查习惯在很大程度上是未知的，但对于现有和未来重症监护信息系统的设计是必要的。方法我们进行了一项调查研究，以评估ICU临床医生接收新患者的电子病历审查实践、信息需求、工作流程和数据显示偏好。我们通过电子邮件对梅奥诊所（明尼苏达州、佛罗里达州和亚利桑那州）的三个地点（明尼苏达州、佛罗里达州和亚利桑那州）的轮转住院医师、重症监护研究员、高级实践提供者和主治医生进行了调查，并发送了一条跟踪提醒信息。结果共邀请234名临床医生，156名完成完整调查，有效率67%。92%的ICU临床医生对大多数新患者进行了电子病历审查。临床医生估计，典型病例的中位数（四分位数范围（IQR））为15（10-20）分钟，复杂病例为25（15-40）分钟，培训水平之间没有差异。对于三分之二的临床医生来说，图表审查的时间跨度为3年或更长，其中最相关的类别是影像学、实验室研究、诊断研究、微生物学报告和临床记录，尽管大部分时间都花在审查记录上。大多数临床医生（77%）担心由于数据量（74%）和显示/组织不足（63%）而忽略重要信息。潜在的解决方案是按时间顺序排列不同的数据类型、颜色编码和显式的数据过滤技术。为不同的用户和不同的临床场景动态定制信息显示的能力是至关重要的。结论：在ICU临床医生中，电子病历回顾是一项重要的、普遍的、潜在的耗时活动，他们将受益于改进的信息显示系统。
Objective The electronic chart review habits of intensive care unit (ICU) clinicians admitting new patients are largely unknown but necessary to inform the design of existing and future critical care information systems.Methods We conducted a survey study to assess the electronic chart review practices, information needs, workflow, and data display preferences among medical ICU clinicians admitting new patients. We surveyed rotating residents, critical care fellows, advanced practice providers, and attending physicians at three Mayo Clinic sites (Minnesota, Florida, and Arizona) via email with a single follow-up reminder message.Results Of 234 clinicians invited, 156 completed the full survey (67% response rate). Ninety-two percent of medical ICU clinicians performed electronic chart review for the majority of new patients. Clinicians estimated spending a median (interquartile range (IQR)) of 15 (10-20) minutes for a typical case, and 25 (15-40) minutes for complex cases, with no difference across training levels. Chart review spans 3 or more years for two-thirds of clinicians, with the most relevant categories being imaging, laboratory studies, diagnostic studies, microbiology reports, and clinical notes, although most time is spent reviewing notes. Most clinicians (77%) worry about overlooking important information due to the volume of data (74%) and inadequate display/organization (63%). Potential solutions are chronologic ordering of disparate data types, color coding, and explicit data filtering techniques. The ability to dynamically customize information display for different users and varying clinical scenarios is paramount.Conclusion Electronic chart review of historical data is an important, prevalent, and potentially time-consuming activity among medical ICU clinicians who would benefit from improved information display systems.