What stands in the way of technology-mediated patient safety improvements?: a study of facilitators and barriers to physicians' use of electronic health records.
What stands in the way of technology-mediated patient safety improvements?: a study of facilitators and barriers to physicians' use of electronic health records.
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DOI：
10.1097/pts.0b013e3182388cfa
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发表时间：
2011-12
影响因子：
2.2
通讯作者：
Holden RJ
中科院分区：
文献类型：
--
作者：
Holden RJ
为了使电子健康记录(EHR)系统对患者安全产生积极影响，临床医生必须能够在这些系统可用后有效地使用它们。这项研究的目的是确定和描述医生使用电子病历系统的促进者和障碍。对在中西部两家社区医院和/或各自的门诊诊所使用EHR的主治医生进行了20次研究访谈。分析产生了200多个感知的促进者和障碍，包括19个不同的类别。与用户属性相关的促进者/障碍类别包括学习、打字熟练程度、对eHR系统的了解、动机/主动性和策略/变通办法。与系统属性相关的类别包括支持硬件/软件以及系统速度、功能和可用性。与他人支持相关的类别有正式的技术支持、正式的培训和同事的非正式支持。组织促进者/障碍的类别是时间津贴和机构间一体化。环境促进者/障碍的类别包括物理空间、电力、无线连接和社会环境。总而言之，广泛发现的促进者和障碍证实并扩大了先前关于卫生信息技术使用的促进者和障碍的研究。通过定性访谈方法报告的关于每个促进者和障碍的信息的深度，有助于从理论上理解促进者和电子病历使用的障碍。同样重要的是，这项研究提供了一个信息基础，可以在此基础上启动相关的政策和设计干预措施，以改善电子病历系统的使用，从而提高患者的安全。
For electronic health records (EHR) systems to have a positive impact on patient safety, clinicians must be able to use these systems effectively after they are made available. This study's objective is to identify and describe facilitators and barriers to physicians' use of EHR systems. Twenty research interviews were conducted with attending physicians who were using EHR at one of two Midwest community hospitals and/or at their respective outpatient clinics. Analyses yielded over 200 perceived facilitators and barriers, comprising 19 distinct categories. Categories of facilitators/barriers related to user attributes included learning, typing proficiency, understanding the EHR system, motivation/initiative, and strategies/workarounds. Categories related to system attributes were supporting hardware/software and system speed, functionality, and usability. Categories related to support from others were formal technical support, formal training, and informal support from colleagues. Categories of organizational facilitators/barriers were time allowance and inter-institutional integration. Categories of environmental facilitators/barriers were physical space, electricity, wireless connectivity, and the social environment. Together, the broad set of discovered facilitators and barriers confirms and expands prior research on the facilitators and barriers to health information technology use. The depth of reported information on each facilitator and barrier made possible by qualitative interview methods contributes to the theoretical understanding of facilitators and barriers to EHR use. Equally as important, this study provides an information base from which relevant policy and design interventions can be launched in order to improve the use of EHR systems and, thus, patient safety.