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首页> 外文期刊>BMC Medical Informatics and Decision Making >Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework
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Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework

机译：初级保健医生对采用电子病历的态度：使用临床采用框架进行系统的审查和证据综合

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Recent decades have seen rapid growth in the implementation of Electronic Medical Records (EMRs) in healthcare settings in both developed regions as well as low and middle income countries. Yet despite substantial investment, the implementation of EMRs in some primary care systems has lagged behind other settings, with piecemeal adoption of EMR functionality by primary care physicians (PCPs) themselves. We aimed to review and synthesise international literature on the attitudes of PCPs to EMR adoption using the Clinical Adoption (CA) Framework. MEDLINE, PsycINFO, and EMBASE were searched from 1st January 1996 to 1st August 2017 for studies investigating PCP attitudes towards EMR adoption. Papers were screened by two independent reviewers, and eligible studies selected for further assessment. Findings were categorised against the CA Framework and the quality of studies assessed against one of three appropriate tools. Out of 2263 potential articles, 33 were included, based in North and South America, Europe, Middle East and Hong Kong. Concerns about the accessibility, reliability and EMR utility exerted an adverse influence on PCPs’ attitudes to adoption. However many were positive about their potential to improve clinical productivity, patient safety and care quality. Younger, computer-literate PCPs, based in large/multi-group practices, were more likely to be positively inclined to EMR use than older physicians, less-skilled in technology use, based in solo practices. Adequate training, policies and procedures favourably impacted on PCPs’ views on EMR implementation. Financial factors were common system level influencers shaping EMR adoption, from start-up costs to the resources required by ongoing use. By using the CA Framework to synthesise the evidence, we identified a linked series of factors influencing PCPs attitudes to EMR adoption. Findings underline the need to involve end-users in future implementation programmes from the outset, to avoid the development of an EMR which is neither feasible nor acceptable for use in practice. PROSPERO CRD42016038790 .
机译：近几十年来，发达地区以及中低收入国家/地区的医疗环境中电子病历（EMR）的实施迅速增长。尽管投入了大量资金，但在一些基层医疗系统中实施EMR仍落后于其他环境，基层医疗医生（PCP）本身也逐步采用了EMR功能。我们旨在通过临床采用（CA）框架回顾和综合有关PCP对采用EMR的态度的国际文献。检索1996年1月1日至2017年8月1日之间的MEDLINE，PsycINFO和EMBASE，以研究PCP对采用EMR的态度。由两名独立审稿人筛选论文，并选择合格的研究作进一步评估。根据CA框架对发现进行分类，并根据三种适当工具之一对研究质量进行评估。在2263篇潜在文章中，有33篇来自北美和南美，欧洲，中东和香港。对可访问性，可靠性和EMR实用性的担忧对PCP的采用态度产生了不利影响。但是，许多人对其提高临床生产率，患者安全性和护理质量的潜力持积极态度。基于大/多组实践的年轻，计算机知识的PCP比起单方面实践，技术使用技能不高的年长医生，更倾向于积极使用EMR。足够的培训，政策和程序对PCP对EMR实施的看法产生了有利影响。从启动成本到持续使用所需的资源，财务因素是影响EMR采用的常见系统级影响因素。通过使用CA框架综合证据，我们确定了一系列相关因素，这些因素影响PCP对采用EMR的态度。研究结果强调，从一开始就需要让最终用户参与未来的实施计划，以避免开发出在实践中不可行也不可接受的EMR。 PROSPERO CRD42016038790。

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