Electronic medical record use in pediatric primary care
Electronic medical record use in pediatric primary care
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DOI：
10.1136/jamia.2010.004135
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发表时间：
2011-01-01
影响因子：
6.4
通讯作者：
Gerber, Andreas
中科院分区：
文献类型：
--
作者：
Fiks, Alexander G.;Alessandrini, Evaline A.;Gerber, Andreas
目的了解儿科初级保健急诊中电子病历的使用模式。设计直接观察性研究，对27名有经验的儿科临床医生进行5 2 9次急诊，每隔20个S间隔，根据戴维斯观察码，记录医生是否只与家人交流，在交流时使用计算机，或不使用计算机。回归模型评估了临床医生、患者和就诊特征对总就诊时长、与家人互动的时间以及在互动时使用电脑的时间的影响。结果平均总就诊时间为11：30(分：秒)，9：06在检查室。临床医生在27%的检查室时间和访问的所有阶段(互动、聊天和建立融洽的关系；记录病史；制定诊断和治疗计划；讨论预防)都使用EMR，但体检除外。与家人的沟通伴随着70%的EMR使用。在回归模型中，检查室外的计算机文档与就诊时间延长了11%(p=0.001)，女性临床医生在交流时使用计算机的时间更长(p=0.003)。限制12项研究实践共享一项电子病历。结论在具有电子病历经验的儿科临床医生中，对话伴随着最多的电子病历使用。我们的结果表明，改善EMR可用性和临床医生EMR培训的努力应该侧重于在医患沟通的背景下使用。有必要进一步研究考场内和考场外的文档对生产率的影响。
Objectives To characterize patterns of electronic medical record (EMR) use at pediatric primary care acute visits.Design Direct observational study of 529 acute visits with 27 experienced pediatric clinician users.Measurements For each 20 s interval and at each stage of the visit according to the Davis Observation Code, we recorded whether the physician was communicating with the family only, using the computer while communicating, or using the computer without communication. Regression models assessed the impact of clinician, patient and visit characteristics on overall visit length, time spent interacting with families, and time spent using the computer while interacting.Results The mean overall visit length was 11:30 (min: sec) with 9:06 spent in the exam room. Clinicians used the EMR during 27% of exam room time and at all stages of the visit (interacting, chatting, and building rapport; history taking; formulation of the diagnosis and treatment plan; and discussing prevention) except the physical exam. Communication with the family accompanied 70% of EMR use. In regression models, computer documentation outside the exam room was associated with visits that were 11% longer (p=0.001), and female clinicians spent more time using the computer while communicating (p=0.003).Limitations The 12 study practices shared one EMR.Conclusions Among pediatric clinicians with EMR experience, conversation accompanies most EMR use. Our results suggest that efforts to improve EMR usability and clinician EMR training should focus on use in the context of doctor patient communication. Further study of the impact of documentation inside versus outside the exam room on productivity is warranted.