Physicians, patients, and the electronic health record: An ethnographic analysis
Physicians, patients, and the electronic health record: An ethnographic analysis
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DOI：
10.1370/afm.425
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发表时间：
2006-03-01
影响因子：
4.4
通讯作者：
Stewart, V
中科院分区：
文献类型：
--
作者：
Ventres, W;Kooienga, S;Stewart, V
目的对电子健康记录(EHR)对医患接触的影响知之甚少。本研究的目的是找出影响医生与病人使用电子健康记录方式的因素。方法这项人种学研究包括4个定性部分：在太平洋西北部的4个初级保健办公室进行了80小时的参与者观察；对52名患者、12名办公室工作人员、23名医生和1名护士进行了个人访谈；对29次临床接触进行了录像回顾；以及对医生和计算机倡导者进行了5次焦点小组访谈。主要的结果指标是影响医生如何使用电子病历的因素。研究人员通过对数据的系列回顾定性地得出了这些因素。结果本研究确定了14个因素，这些因素影响了当今医疗实践中如何使用和感知EHR。这些因素被分为四个主题领域：(1)电子病历的物理存在和位置对医患互动的空间效应；(2)医生和患者对电子病历的关系认知以及这些认知如何影响其使用；(3)教育问题--发展医生对电子病历使用的熟练程度和提高患者对电子病历使用的理解；(4)影响医生如何感知其使用电子病历的结构-制度和技术力量。结论本研究发现，将电子病历引入临床实践会影响临床接触的多个认知和社会维度。它使重要的问题成为焦点，通过进一步的调查可以确定如何最好地利用电子病历来加强治疗关系。
PURPOSE Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients.METHODS This ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offices in the Pacific Northwest; individual interviews with 52 patients, 12 office staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focus-group interviews with physicians and computer advocates. The main outcome measures were factors that influence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data.RESULTS This study identified 14 factors that influence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial-effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational - perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational - issues of developing physicians' proficiency with and improving patients' understandings about EHR use; and (4) structural - institutional and technological forces that influence how physicians perceived their use of EHR.CONCLUSIONS This study found that the introduction of EHRs into practice influences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships.