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Technical limitations of electronic health records in community health centers: Implications on ambulatory care quality.

机译：社区卫生中心电子卫生记录的技术局限性：对门诊服务质量的影响。

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摘要

Research objectives. This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the potential of the EHR to improve quality of care and showing a lack of improvement associated with EHR use. This study examines the role that the state of development of EHR functionalities plays in the quality improvement.;Study design. A qualitative study of four community health center (CHC) networks that provide EHR services to members and three CHCs from each network. Each network used different, commonly used and CCHIT certified EHRs. Sixty five hours of interviews were transcribed, coded, and analyzed from seventy five semi-structured interviews of leaders/staff. The analysis focused on the eight core EHR functionalities as identified by the IOM.;Principal findings. Out-of-the-box, none of the EHRs studied strongly supported the provision of guideline based care to individual patients or the management of populations of patients. Extensive EHR modification was needed, with some EHRs requiring more work. Challenges were most acutely felt with templates, interfaces, decision support, and reporting functionalities. Limitations were found less often in administrative processes and within practice messaging. Though EHR functionalities greatly improved based on network and CHC development efforts, focus on quality improvement activities was diminished by the consumption of scarce resources to fix poorly functioning software.;Conclusions. Given that EHR adoption rates will continue to increase it should be emphasized that successful QI efforts are difficult to achieve with the current state of the technology, especially for smaller practices. So far the onus of improving the functionalities for use in QI efforts has primarily been left to the EHR adopters, who generally lack the resources to develop the software. Policy needs to take this into account and fund not only EHR implementation, but also ensure great improvements are made to core functionalities.
机译：研究目标。本论文检查了IOM所描述的八个核心电子健康记录（EHR）功能中每个功能的开发状态，并描述了这些功能的当前状态如何限制非卧床护理环境中的质量改进工作。有大量文献描述了电子病历改善医疗质量的潜力以及缺乏与电子病历使用相关的改善。本研究探讨了电子病历功能的发展状况在质量改进中的作用。研究设计。对四个向会员提供EHR服务的社区卫生中心（CHC）网络和每个网络中的三个CHC的定性研究。每个网络使用不同的，常用的和CCHIT认证的EHR。从对领导者/员工的75个半结构化访谈中，转录，编码和分析了65小时的访谈。分析着重于IOM确定的八项EHR核心功能。主要发现。开箱即用，没有研究过的EHR强烈支持为个别患者或患者群体的管理提供基于指南的护理。需要对EHR进行大量修改，有些EHR需要更多的工作。模板，界面，决策支持和报告功能最明显地带来了挑战。在管理过程和实践消息传递中很少发现局限性。尽管基于网络和CHC开发的努力，EHR功能得到了极大的改善，但由于用于修复功能较差的软件的稀缺资源的消耗，对质量改进活动的关注减少了。鉴于EHR的采用率将继续增加，应强调的是，利用当前的技术状态，尤其是对于较小的实践，很难成功地进行QI努力。到目前为止，改善QI工作中使用的功能的责任主要留给了EHR采用者，他们通常缺乏开发软件的资源。政策需要考虑到这一点，不仅要为电子病历的实施提供资金，还要确保对核心功能进行重大改进。

著录项

  • 作者

    West, Christopher E.;

  • 作者单位

    University of California, San Francisco.;

  • 授予单位 University of California, San Francisco.;
  • 学科 Information Technology.;Information Science.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 126 p.
  • 总页数 126
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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