Response to Letter: Secondary use of electronic health record data for clinical workflow analysis.
Response to Letter: Secondary use of electronic health record data for clinical workflow analysis.
复制标题
对信的回应：电子健康记录数据的二次使用用于临床工作流程分析。
DOI：
10.1093/jamia/ocy030
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Chiang,MichaelF
中科院分区：
文献类型：
--
作者：
Hribar,MichelleR;Chiang,MichaelF
回应：Black和Klubert博士在他们的信中提出了3点关于使用电子健康记录（EHR）时间戳数据进行工作流程计时和建模的局限性1：（1）我们的方法可能无法推广到眼科以外的其他专业。我们同意其他医学专业的不同工作流程可能无法通过EHR时间戳准确表示。然而，我们注意到，我们方法的一个关键部分涉及在使用它们之前仔细分析和映射这些单独的工作流程到EHR时间戳。我们很高兴我们的方法在一个眼科部门的27个不同的提供者中起作用，并希望其他研究人员有兴趣将它们应用于其他环境。(2)我们的方法不计时患者遭遇的颗粒细节。我们同意这是正确的，但请注意，本出版物的目的不是测量患者就诊期间的特定EHR活动。相反，我们的目标是估计临床检查时间和文档时间，并确定学员参与的遭遇。我们目前正在扩展我们的研究，以开发测量更细粒度活动的方法。(3)我们的方法反映了提供者EHR的使用，这可能与患者就诊期间的实际提供者活动不匹配。我们完全同意这一限制，并在文件中指出。再次，我们强调，我们的研究的目的是研究使用EHR时间戳的工作流程研究，无论是否EHR活动发生在遇到或之后it. We同意博士Klubert和黑色的声明，在EHR用户界面和临床工作流程的改进是必要的。2- 4总的来说，我们发现，大量的现成的EHR数据是一个明显的好处，工作流程研究，如果小心使用。虽然不完美，但它可用于模拟模型测试人员配备，诊所工作流程，诊所资源等的变化，因为它们评估的是相对比较而不是绝对比较。类似地，假设EHR使用模式保持不变，则EHR定时数据可用于比较实施变更后诊所时间的相对差异。我们感谢Klubert博士和Black博士在他们的信中讲述了他们在EHR时间戳方面面临的挑战，并鼓励他们在未来发表他们的研究结果，以便我们可以将我们的具体结果与他们的进行比较。
Response: Drs Black and Klubert raise 3 points in their letter about the limitations of using electronic health record (EHR) timestamp data for workflow timing and modeling 1:(1) Our methodologies may not generalize to other specialties beyond ophthalmology. We agree that different workflows in other medical specialties may not be accurately represented by EHR timestamps. We note, however, that a key part of our methodology involves careful analysis and mapping of those individual workflows to EHR timestamps before using them. We are pleased that our methods appear to work among 27 different providers within a single ophthalmology department, and hope other researchers will be interested in applying them in other settings.(2) Our methodologies do not time the granular details of the patient encounter. We agree that this is correct, but note that the goal of this publication was not to measure specific EHR activities during a patient encounter. Instead, our goals were to estimate clinical exam times and documentation time, and to identify trainee involvement in the encounter. We are currently extending our research to develop methodologies for measuring more granular activities.(3) Our methodologies reflect provider EHR use, which may not match actual provider activity during the patient encounter. We completely agree with this limitation and noted it in the paper. Again, we emphasize that the purpose of our study was studying the use of EHR timestamps in workflow research regardless of whether the EHR activity took place during the encounter or after it. We agree with Drs Klubert and Black’s statement that improvement in EHR user interfaces and clinical workflow is warranted. 2–4Overall, we have found that the large volume of readily available EHR data is a distinct benefit for workflow studies, if used carefully. While imperfect, it can be used for simulation models testing changes to staffing, clinic workflows, clinic resources, etc., since they evaluate relative rather than absolute comparisons. Similarly, EHR timing data can be used to compare the relative difference in clinic times after changes are implemented, assuming that EHR use patterns remained the same. We appreciate Drs Klubert and Black’s anecdotes of their challenges with EHR timestamps in their letter, and encourage them to publish their findings in the future so we can compare our specific results with theirs.