从幕后看:在大型商业电子病历实施过程中,识别导致护理结果变化的因素。

Tiago K Colicchio, Damian Borbolla, Vanessa D Colicchio, Debra L Scammon, Guilherme Del Fiol, Julio C Facelli, Watson A Bowes, Scott P Narus
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引用次数: 10

摘要

目的:确定在大型商业电子健康记录(EHR)实施过程中导致质量、生产力和安全结果变化的因素,并指导未来的研究。方法:我们进行了一项混合方法研究,评估商业电子病历实施的影响。该方法包括定量的纵向评估,然后是定性的半结构化,与来自同一实施的临床员工进行深入访谈。14次采访被记录和转录。三位作者独立编码采访叙述,并通过共识确定了影响质量、生产力和安全15个结果变化的因素。结果:我们确定了14个可能影响先前监测结果的因素。我们的研究结果表明,与实施相关(例如,不完整的数据迁移)、部分相关(例如,故意减少工作量)和不相关(例如,健康保险变更)的几个因素可能以不同的方式影响结果。讨论:这是第一个在大型纵向评估结果的指导下,调查在电子病历实施过程中导致质量、生产力和安全结果变化的因素的研究。所确定的各种因素表明,组织需要进行调整以充分利用新技术,这对保健和其他服务部门同样重要。结论:我们建议在未来的评估中持续识别和监测这些因素,以期增加我们对卫生信息技术干预措施的全面影响的理解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation.

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation.

Objective: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research.

Methods: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation. Fourteen interviews were recorded and transcribed. Three authors independently coded interview narratives and via consensus identified factors contributing to changes on 15 outcomes of quality, productivity, and safety.

Results: We identified 14 factors that potentially affected the outcomes previously monitored. Our findings demonstrate that several factors related to the implementation (e.g., incomplete data migration), partially related (e.g., intentional decrease in volume of work), and not related (e.g., health insurance changes) may affect outcomes in different ways.

Discussion: This is the first study to investigate factors contributing to changes on a broad set of quality, productivity, and safety outcomes during an EHR implementation guided by the results of a large longitudinal evaluation. The diversity of factors identified indicates that the need for organizational adaptation to take full advantage of new technologies is as important for health care as it is for other services sectors.

Conclusions: We recommend continuous identification and monitoring of these factors in future evaluations to hopefully increase our understanding of the full impact of health information technology interventions.

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