Barriers to organizational adoption of EMR systems in family physician practices: A mixed-methods study in Canada
Barriers to organizational adoption of EMR systems in family physician practices: A mixed-methods study in Canada
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DOI：
10.1016/j.ijmedinf.2014.06.003
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发表时间：
2014-08-01
影响因子：
4.9
通讯作者：
Micheneau, Thomas
中科院分区：
文献类型：
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作者：
Pare, Guy;Raymond, Louis;Micheneau, Thomas
工作背景：EMR系统可以提供三种主要类型的好处：它可以解决与纸质系统相关的后勤组织问题;它可以提高专业人员临床决策的质量;它可以通过降低管理临床信息的成本来提高医生的实践回报。根据2012年英联邦基金国际卫生政策调查，加拿大在家庭医生采用EMR系统方面在11个国家中排名第10位。我们的主要目的是调查的原因，为什么这么多的初级保健医疗实践在这个国家还没有决定投资于这些systems yet.Methods：为了实现我们的主要目标，混合方法的研究进行。我们首先进行了一项德尔菲研究小组的21名专家组成的全科医生具有丰富的专业经验和非常好的理解周围的问题，在私人医疗实践中引入健康信息技术。作为第二步，我们收集和分析数据，从一个大型的问卷调查的家庭医生工作的医疗实践中没有电子病历systems（n = 431）。结果：德尔菲研究表明，私人医疗实践中遇到的四种类型的障碍时，面临的初步决定投资于电子病历系统，即行为，认知或知识为基础的，经济和技术。调查结果表明，阻止私人医疗机构投资电子病历系统的主要挑战主要与经济和知识障碍有关。令人惊讶的是，我们还发现了一个集群的医疗实践，虽然他们没有投资于电子病历系统，感知没有这样的障碍adoption.Conclusions：通过电子病历系统的家庭医生的做法所面临的障碍的透彻理解，将有助于政府和其他主要利益相关者的目标政策和措施，支持医疗实践。这种政策和措施的“一刀切”的做法显然是不合适的，因为这项研究的结果是，许多医疗实践在采用电子病历方面几乎没有障碍，而其他医疗实践在所面临的障碍类型方面存在明显差异，无论是知识障碍等“软”障碍，还是经济障碍等“硬”障碍。(C)2014爱思唯尔爱尔兰有限公司版权所有。
Background: EMR system can provide three main types of benefits: it can solve the logistical organization problems associated with paper systems; it can improve the quality of professionals' clinical decisions; and it can improve physicians' return on their practices by reducing the cost of managing clinical information. According to the 2012 Commonwealth Fund International Health Policy Survey, Canada ranked 10th out of 11 countries in terms of family physicians' adoption of EMR systems. Our main purpose is to investigate the reasons why so many primary care medical practices in this country have not decided to invest in these systems yet.Methods: To achieve our main objective, a mixed-methods study was performed. We first conducted a Delphi study with a panel of 21 experts made up of general practitioners with extensive professional experience and a very good understanding of the issues surrounding the introduction of health IT in private medical practices. As a second step, we collected and analyzed data from a large questionnaire survey of family physicians working in medical practices without EMR systems (n = 431).Results: The Delphi study reveals that private medical practices are hindered by four types of barriers when faced with the initial decision to invest in an EMR system, namely, behavioral, cognitive or knowledge-based, economic, and technological. Survey findings then indicate that the key challenges preventing private medical practices from investing in an EMR system are mainly related to economic and knowledge barriers. Surprisingly, we also found a cluster of medical practices which, although they have not invested in an EMR system, perceive no such barriers to adoption.Conclusions: A thorough understanding of the barriers faced by family physician practices in adopting an EMR system would help governments and other key stakeholders target policies and measures in support of medical practices. The "one size fits all" approach to such policies and measures is clearly inappropriate, given this study's findings that many medical practices face practically no barriers to EMR adoption, and that others differ markedly as to the type of barriers faced, be they mostly "soft" such as knowledge barriers or "hard" such as economic barriers. (C) 2014 Elsevier Ireland Ltd. All rights reserved.