Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review.
Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review.
复制标题
电子健康记录对心理健康背景下信息实践的影响：范围审查。
DOI：
10.2196/30405
复制
发表时间：
2022-05-04
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
在心理健康方面，采用电子健康记录和电子病历的速度缓慢，部分原因是对敏感信息的收集、心理健康数据的标准化以及对治疗关系产生负面影响的风险的担忧。然而，EHR和EMR越来越被视为改善信息实践的关键，例如信息的记录，使用和共享，以及更广泛地说，所提供的护理质量。本文的目的是进行范围审查，探讨在精神卫生环境中的信息实践的影响，并探讨如何敏感的信息，数据标准化，和治疗关系的管理时，在精神卫生环境中使用EHR。我们认为范围审查是最合适的方法，因为EHR在精神卫生方面的相对较新的摄取。对电子数据库进行了全面检索，没有日期限制，以查找描述在精神卫生背景下使用EHR、EMR或相关系统的文章。其中一位作者审查了所有全文，另外2位作者各筛选了一半的全文文章。第四提交人调解了分歧。绘制了关于研究特征的数据。本研究采用叙事和主题综合的研究方法，对所纳入的研究结果进行分析并提出研究问题。最终纳入40篇文章。纳入的研究具有高度异质性，具有各种研究设计、目的和设置。确定了几个主题和次主题，探讨了EHR对精神卫生领域信息实践的影响。与纸质文件相比，电子健康记录提高了记录的信息量。然而，电子健康记录中经常缺少与心理健康有关的信息，特别是敏感信息。电子健康记录引入了更加标准化和正规化的记录做法，由于在心理健康背景下侧重于叙述性信息，因此提出了一些问题。EHR被发现会破坏心理健康方面的信息工作流程，特别是当它们不包括适当的模板或护理计划时。可用性问题也导致了工作流程问题。管理电子病历中敏感信息的文档是有问题的;临床医生有时会淡化敏感信息或选择将其保存在单独的记录中。令人担忧的是，纳入的研究很少涉及服务用户的观点。此外，许多研究提供了关于所使用的电子健康记录的功能或技术规格的有限信息。我们确定了几个需要开展工作的领域，以确保EHR在心理健康方面使临床医生和服务用户受益。随着EHR越来越被认为对现代卫生系统至关重要，医疗保健决策者应该考虑EHR如何更好地反映精神卫生背景下信息实践和工作流程的复杂性和敏感性。
The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions. The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
DOI：
10.1176/appi.ps.201900470
发表时间：
2020-10-01
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Matthews EB;Stanhope V
通讯作者：
Stanhope V