How patients can improve the accuracy of their medical records.
How patients can improve the accuracy of their medical records.
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DOI：
10.13063/2327-9214.1080
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发表时间：
2014-01-01
期刊：
影响因子：
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通讯作者：
Evans, Michael A
中科院分区：
文献类型：
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作者：
Dullabh, Prashila M;Sondheimer, Norman K;Evans, Michael A
目标：评估 (1) 如果患者有效地使用网络个人健康记录，是否可以提高其医疗记录的准确性； (2)接收和处理患者反馈的工作流程效率和可靠性； (3) 患者反馈对医疗记录准确性的影响。背景：提高医疗记录准确性和相关挑战已被广泛记录。通过信息技术为患者提供对其记录的有用访问，为他们提供了提高记录准确性和完整性的新机会。在线患者参与倡导者 Geisinger Health Systems 的患者采用了一种支持患者在线提交药物清单的新方法，该方法表明这是可以成功完成的。 2011 年底，Geisinger 启动了一个在线流程，让患者在就诊前就其药物清单的准确性提供电子反馈。患者反馈被发送给 Geisinger 药剂师，药剂师对其进行审查并进行跟进，然后更改患者和临床医生共享的药物清单。方法：评估采用混合方法，包括患者焦点小组（反馈表的用户、非用户和部分用户）、对提供者和药剂师的半结构化访谈、用户对患者的观察以及对患者反馈数据和药剂师的药物协调的定量分析。调查结果/讨论：（1）患者渴望提供有关其药物的反馈，并看到了许多优点。百分之三十的患者反馈表（1,500 份中的 457 份）已完成并提交给 Geisinger。 89% 的患者要求更改共享药物清单（414 份表格中的 369 份）。其中包括现有处方的频率或剂量变化以及对新药物（处方药和非处方药）的要求。 (2)患者提供有用且准确的在线反馈。在 107 份表格的子样本中，药剂师对 68% 的患者更改药物清单的请求做出了积极回应。 (3) 处理患者反馈需要软件算法和人工解释。对于 107 个表格子样本，药剂师在无法联系患者的情况下，在 51% 的情况下接受了患者的输入。在联系患者时，他们接受了 68% 的反馈。这表明可能有机会自动进行反馈过滤和处理，以实现更有效（和更大规模）的药物列表优化。 (4) 支持性的整体电子医疗环境使在线患者反馈系统更有可能被接受。对 Geisinger 使用数据的审查显示，完成药物反馈表的患者之前访问 MyGeisinger 的频率是普通患者的 2.3 倍，向临床医生发起安全消息的频率是未参与试点的患者的 1.35 倍。结论：将患者反馈置于有用的工作流程中可以提高医疗记录的准确性。电子健康记录 (EHR) 供应商和开发人员需要在应用程序中构建适当的功能。需要持续的研究和开发，使医疗保健组织能够最有效地获取和处理患者信息。
OBJECTIVES: Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy.BACKGROUND: Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians.METHODS: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs.FINDINGS/DISCUSSION: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for medication list changes. (3) Processing patient feedback will requires both software algorithms and human interpretation. For the 107 forms subsample, pharmacists accepted patient input in 51 percent of cases where they could not contact the patient. Where the patient was contacted, they accepted feedback from 68 percent. This suggests there may be opportunities to automate feedback filtering and processing for more efficient (and larger scale) medication-list optimization. (4) A supportive overall e-health environment makes acceptance of an online patient feedback system more likely. Review of Geisinger usage data showed patients who completed the medication feedback form had previously accessed MyGeisinger 2.3 times as often as the average patient and initiated secure messages with a clinician 1.35 times as often as patients not involved in the pilot.CONCLUSIONS: Patient feedback, placed in a useful workflow, can improve medical record accuracy. Electronic health record (EHR) vendors and developers need to build appropriate capabilities into applications. Continued research and development is needed for enabling health care organizations to elicit and process patient information most effectively.