Challenges optimizing the after visit summary
Challenges optimizing the after visit summary
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DOI：
10.1016/j.ijmedinf.2018.09.009
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发表时间：
2018-12-01
影响因子：
4.9
通讯作者：
Kannry, Joseph
中科院分区：
文献类型：
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作者：
Federman, Alex;Sarzynski, Erin;Kannry, Joseph
背景：就诊后总结(AVS)是一种纸质或电子文档，旨在总结患者的健康状况并指导未来的护理，包括自我管理任务。目的：描述卫生系统在市售电子健康记录(EHR)系统中实施重新设计的门诊AVS的经验，以指导未来的优化。材料和方法：我们对美国大陆12家医院和社区医疗机构的信息技术和临床负责人进行了半结构化访谈，重点关注AVS的重新设计和实施过程。我们还报告了我们在纽约西奈山医院的Epic EHR中实施重新设计的AVS的经验。结果：卫生系统在实施重新设计的AVS时遇到了许多挑战。虽然许多IT领导者指出，重新设计的AVS更容易理解，文档也更有条理，但他们声称，这一努力很耗时，EPIC系统升级使AVS修改无法发挥作用，初级保健和专科实践在内容和格式方面有不同的需求。我们的团队能够通过更改打印组的顺序、修改字体大小、加粗部分标题和插入分页符来修改文档。与其他医疗系统类似，我们的团队发现，由于EHR平台的限制，一些期望的功能很难实现。结论：医疗IT领导者将AVS视为患者的宝贵信息来源。然而，在EHR系统中对AVS修改的限制给优化该工具带来了挑战。电子病历供应商应该从医疗保健系统创新努力中吸取教训，并考虑在其产品开发中建立更多的灵活性。
Background: The after visit summary (AVS) is a paper or electronic document given to patients after a medical appointment, which is intended to summarize patients' health and guide future care, including self-management tasks.Objective: To describe experiences of health systems implementing a redesigned outpatient AVS in commercially available electronic health record (EHR) systems to inform future optimization.Materials and Methods: We conducted semi-structured interviews with information technology and clinical leaders at 12 hospital and community-based healthcare institutions across the continental United States focusing on the process of AVS redesign and implementation. We also report our experience implementing a redesigned AVS in the Epic EHR at the Mount Sinai Hospital in New York City, NY.Results: Health systems experienced many challenges implementing the redesigned AVS. While many IT leaders noted that the redesigned AVS is easier to understand and the document is better organized, they claim the effort is time-consuming, Epic system upgrades render AVS modifications non-functional, and primary care and specialty practices have different needs in regards to content and formatting. Our team was able to modify the document by changing the order of print groups, modifying the font size, bolding section headers, and inserting page breaks. Similar to other health systems, our team found that it is difficult to achieve some desired features due to limitations in the EHR platform.Conclusion: Health IT leaders view the AVS as a valuable source of information for patients. However, limitations to AVS modifications in EHR systems present challenges to optimizing the tool. EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.