Implementing an electronic medical record in a family medicine practice: Communication, decision making, and conflict
Implementing an electronic medical record in a family medicine practice: Communication, decision making, and conflict
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DOI：
10.1370/afm.326
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发表时间：
2005-07-01
影响因子：
4.4
通讯作者：
Crabtree, BF
中科院分区：
文献类型：
--
作者：
Crosson, JC;Stroebel, C;Crabtree, BF
电子病历（EMR）系统为组织和管理临床数据提供了大量的机会，这些数据可以潜在地改善预防性卫生保健、慢性病管理和初级保健实践的财务健康。然而，所实现的EMR的功能可能与其设计者甚至购买程序的人所设想的功能有很大不同。本研究的目的是探讨家庭医学办公室文化的独特方面如何影响最初实施的EMR. METHODS作为一个更大的研究的一部分，我们进行了一个定性的案例研究的私人家庭医学的做法，最近购买并实施了EMR。我们通过参与者观察、深度访谈和关键线人访谈收集数据。最初的数据收集后，我们分享我们的观察与实践成员，并返回一年后收集额外的data.Results功能失调的沟通模式，正式和非正式的决策权的分布，和内部冲突限制了有效的实施和使用的EMR。的实施和使用的电子病历作出跟踪和监测的预防性健康和慢性疾病笨拙和提供很少或根本没有改善时，与纸质charts.Conclusions实施电子病历没有了解的系统性影响和沟通和决策-在办公室实践中制定流程，而没有方法来揭示和解决冲突，限制了通过以下方式提供更好的护理的机会：电子病历了解这些共同问题如何在独特的实践环境中表现出来，可以加强有效实施和使用电子病历。
PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the financial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine office culture affect the initial implementation of an EMR.METHODS As part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned I year later to collect additional data.RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal conflicts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an office practice and without methods for bringing to the surface and addressing conflicts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs.