Evaluating a scalable model for implementing electronic health records in resource-limited settings.
Evaluating a scalable model for implementing electronic health records in resource-limited settings.
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评估在资源有限的环境中实施电子健康记录的可扩展模型。
DOI：
10.1136/jamia.2009.002303
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
Tierney,WilliamM
中科院分区：
文献类型：
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作者：
Were,MartinC;Emenyonu,Nneka;Achieng,Marion;Shen,Changyu;Ssali,John;Masaba,JohnPM;Tierney,WilliamM
在资源有限的环境中实施电子健康记录（EHR）的当前模式可能无法扩展，因为它们无法解决人力资源和成本限制。本文描述了一种实施模式，它依赖于本地站点和外部三管齐下的支持基础设施之间的责任分担：（1）国家技术专家中心，（2）实施者的社区，和（3）开发人员的社区。该模型被用于在乌干达的三个艾滋病诊所实施开源EHR。在一个地点进行的前后时间-运动研究显示，在实施EHR后，初级保健提供者在直接和间接护理患者上花费的时间减少了三分之一（p<0.001），在个人活动上花费的时间增加了40%（p=0.09）。以前登记的患者与非临床工作人员的时间减少了一半（p=0.004），与药房的时间减少了63%（p<0.001）。接受调查的供应商对EHR及其支持基础设施非常满意。这种模式为在资源有限的环境中广泛实施EHR提供了一种可行的方法。
Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre–post time–motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.