Centers speak up: The clinical context for health information technology in the ambulatory care setting
Centers speak up: The clinical context for health information technology in the ambulatory care setting
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DOI：
10.1007/s11606-007-0488-6
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发表时间：
2008-04-01
影响因子：
5.7
通讯作者：
Burstin, Helen
中科院分区：
文献类型：
--
作者：
Leu, Michael G.;Cheung, Ming;Burstin, Helen
背景：越来越多的人呼吁门诊医疗机构的临床医生使用健康信息技术（health IT）来提高实践效率和绩效。成功采用健康 IT 需要了解临床任务和工作流程将如何受到影响；但这还没有得到很好的描述。目的：描述卫生信息技术在临床背景下如何发挥作用。设计：使用深入、半结构化访谈进行定性研究。参与者：4 个社区卫生中心、3 个卫生中心网络和 1 个大型初级保健组织的高管和工作人员。方法：转录录音访谈，使用持续比较方法进行分析。结果：临床背景的系统特征确定了 6 个主要临床领域。其中包括结果管理、诊所内沟通、患者教育和外展、诊所间协调、药物管理以及提供者教育和反馈。我们生成了临床流程图来描述这些领域的特征。参与者建议，这些领域的基础工作流程必须全面运行，以确保成功部署卫生 IT。结论：了解临床背景是成功部署卫生 IT 的必要前提。流程图可以作为 EHR 认证的基础，以识别挑战、衡量健康 IT 的采用情况或开发有关健康 IT 在临床实践中的作用的课程内容。
BACKGROUND: Clinicians in ambulatory care settings are increasingly called upon to use health information technology (health IT) to improve practice efficiency and performance. Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described.OBJECTIVE: To describe how health IT functions within a clinical context.DESIGN:Qualitative study, using in-depth, semi-structured interviews.PARTICIPANTS: Executives and staff at 4 community health centers, 3 health center networks, and 1 large primary care organization.APPROACH: Transcribed audio-recorded interviews, analyzed using the constant comparative method.RESULTS: Systematic characterization of clinical context identified 6 primary clinical domains. These included results management, intra-clinic communication, patient education and outreach, inter-clinic coordination, medication management, and provider education and feedback. We generated clinical process diagrams to characterize these domains. Participants suggested that underlying workflows for these domains must be fully operational to ensure successful deployment of health IT.CONCLUSIONS: Understanding the clinical context is a necessary precursor to successful deployment of health IT. Process diagrams can serve as the basis for EHR certification, to identify challenges, to measure health IT adoption, or to develop curricular content regarding the role of health IT in clinical practice.