电子健康档案建设中的利益相关者分析

通过利益相关者理论分析电子健康档案建设中的利益相关者。主要利益相关者是居民、卫生行政部门、基层医疗卫生机构、医务人员、软件供应商,次要利益相关者是公共卫生专业机构、财政部门、其他相关行政部门和第三方。通过分析,提出推进电子健康档案建设的对策建议。     

国内外电子健康档案建设概况

电子健康档案研究是当今国内外卫生信息化的热点。对国内外电子健康档案建设现状以及我国电子健康档案建设存在问题做了综述,主要从发展背景、政策法规、数据标准及系统架构方面进行比较,指出电子健康档案建设在总体设计、支持力度、利益协调、推广引导等方面存在的不足。     

基于政策工具的我国精神卫生政策文本分析

目的：为了解我国目前已经出台的精神卫生政策现状和特点,探讨现有政策体系的侧重点并剖析存在的问题,对我国国家层面出台的精神卫生政策文本进行研究,以期为推动我国精神卫生事业迅速发展、为政府未来制定与优化精神卫生领域政策提供参考。方法：选取1986-2021年我国在国家层面发布的有关精神卫生的政策文本76份,然后运用关键词词频分析法对精神卫生政策主题侧重点进行分析,再利用内容分析法构建“政策工具-管理过程-利益相关者”三维分析框架,从3个维度对我国精神卫生政策的文本内容进行分析。结果：76份精神卫生政策的主要关键词为“服务”“健康”;在政策工具维度,精神卫生政策总体呈现出重环境型政策工具、轻需求型政策工具的特点;在管理过程维度,精神卫生政策主要聚焦于预防阶段;在利益相关者维度,政府与政府部门是政策出台与执行的主要利益相关者。结论：应优化调配政策工具,平衡各利益相关者需求,增强政策多维耦合性,提高政策可操作性,构建能够更好地为精神卫生、心理健康服务的精神卫生政策体系。     

基于政策工具的各省份电子健康档案相关政策分析

目的：分析我国各省份电子健康档案管理的相关政策,为调整优化政策结构提供参考。方法：以各省级政府、卫生健康委员会等网站为基础资料来源,收集2009年―2022年电子健康档案相关政策文件,从政策工具与电子健康档案业务发展阶段两个维度进行量化分析。结果：共收集我国各省份颁布的电子健康档案相关政策文件535份,累计编码650条。电子健康档案政策综合运用了环境型、供给型和需求型3类政策工具,分别占42.47%、27.38%、30.15%,应用推广阶段、基础建设阶段的政策工具条目占比分别为54.92%、45.08%。结论：各省份电子健康档案政策发展不均衡,政策工具运用单一化,可结合业务发展,细化业务分类,均衡运用政策工具。     

我国电子健康档案建立与应用进展

电子健康档案的发展是全球数字化的必然趋势，介绍电子健康档案的建立与国家相关政策，阐述电子健康档案在德阳、上海、北京、广州、南昌等地的建设实践，对未来发展进行展望，为其他省市电子健康档案的建设提供有益参考。     

电子健康档案的价值认知与应用推进策略研究

介绍电子健康档案的实践发展和理论研究现状，阐述电子健康档案具有应用于多方面的可能性、改善健康信息的可获得性、提高健康决策的效果、促进医疗卫生机构间协作4个方面的独特价值。分析美国电子健康档案应用推进策略，提出我国推进电子健康档案采纳应用可从社会认知的提升、组织机构的保障、政策文件的引导、法律体系的配套、标准规范的完善5方面着手。     

社区医疗机构向个人开放电子健康档案的意义与挑战

电子健康档案是社区卫生发展的重要信息化手段之一。2018-06-20,国家卫生健康委员会（原国家卫生和计划生育委员会）相关文件要求社区应逐步推行电子健康档案向个人开放。为探索其可能的影响和意义,本文回顾国内外社区电子健康档案的历史与发展情况,了解关于推行电子健康档案向个人开放的相关研究,发现当前我国电子健康档案利用率低、维护率低,尚未发挥应有的价值。推行电子档案向个人开放,其未来发展的方向包括健康提醒、医患沟通、自我管理等,意义在于改善医疗结局、以患者为中心、提升患者满意度等,但推行电子档案向个人开放仍然需要解决诸多问题,如国家政策支持、技术和资金支持、人员配备及信息安全隐患等。     

医社协同与社区智慧健康小屋：分级诊疗路径再建构

背景 分级诊疗自实施以来进展缓慢,其中对多元主体和利益相关者分析的全面性不足是重要原因之一。目的 通过分析分级诊疗中多元主体的利益关系,探讨能结合自上而下和自下而上双重路径的机制创新方案,通过政策创新和路径创新,助力多元主体协同治理,优化分级分流的就医秩序。方法 于2022-10-10—2023-03-20选取2个国内先进城市的先进城区（X市S区和N市H区）为典型调研区,通过滚雪球抽样和目的抽样法,选取典型调研区内36位不同利益相关者（涉及市级卫生行政部门、三级医院管理者、三级医院专科医生、社区卫生服务中心管理者、全科医生、健康社工师、患者等7类主体）为研究对象开展深度访谈,运用利益相关者的理论分析方法,分析7大利益主体之间的利益纠葛和掣肘及其对分级诊疗就医秩序健康发展的制约,以探索分级诊疗的机制困境;并对X市S区和N市H区实施健康社工和社区智慧健康小屋试点地区和非试点地区的典型利益相关者的访谈记录进行文本分析,以对比实施前后的效果。结果 深度访谈结果显示,“利益相关程度、实施意愿程度、受实施影响程度和对实施影响力”4大维度是影响7类主体实施分级诊疗的主要方面,7大主体有各自利益立场,...     

电子健康档案发展国际经验研究

分析美国、英国、加拿大、澳大利亚等部分国家电子健康档案的发展历程,总结归纳其在组织规划、资金投入、政策立法、标准规范、安全与隐私保障、推广应用等方面的具体做法及对我国电子健康档案的启示.     

军队人员电子健康档案的总体框架设计与应用

军人电子健康档案是广大官兵享有均等化公共卫生服务的重要体现，详细介绍了军人电子健康档案的系统架构、技术标准、需求模型以及建设目标和主要功能，并总结了军区应用电子健康档案的初步成效，旨在为军队电子健康档案建设提供参考。     

A systematic review of contributing factors of and solutions to electronic health record–related impacts on physician well-being

ObjectivePhysicians often describe the electronic health record (EHR) as a cumbersome impediment to meaningful work, which has important implications for physician well-being. This systematic review (1) assesses organizational, physician, and information technology factors associated with EHR-related impacts on physician well-being; and (2) highlights potential improvements to EHR form and function, as recommended by frontline physicians.Materials and methodsThe MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science databases were searched for literature describing EHR use by physicians and markers of well-being.ResultsAfter reviewing 7388 article, 35 ultimately met the inclusion criteria. Multiple factors across all levels were associated with EHR-related well-being among physicians. Notable predictors amenable to interventions include (1) total EHR time, (2) after-hours EHR time, (3) on-site EHR support, (4) perceived EHR usability, (5) in-basket burden, and (6) documentation burden. Physician recommendations also echoed these themes.ConclusionsThere are multiple complex factors involved in EHR-related well-being among physicians. Our review shows physicians have recommendations that span from federal regulations to organizational policies to EHR modifications. Future research should assess multipronged interventions that address these factors. As primary stakeholders, physicians should be included in the planning and implementation of such modifications to ensure compatibility with physician needs and clinical workflows.     

Harmonized patient-reported data elements in the electronic health record: supporting meaningful use by primary care action on health behaviors and key psychosocial factors

Background

Electronic health records (EHR) have the potential to improve patient care through efficient access to complete patient health information. This potential may not be reached because many of the most important determinants of health outcome are rarely included. Successful health promotion and disease prevention requires patient-reported data reflecting health behaviors and psychosocial issues. Furthermore, there is a need to harmonize this information across different EHR systems.

Methods

To fill this gap a three-phased process was used to conceptualize, identify and recommend patient-reported data elements on health behaviors and psychosocial factors for the EHR. Expert panels (n=13) identified candidate measures (phase 1) that were reviewed and rated by a wide range of health professionals (n=93) using the grid-enabled measures wiki social media platform (phase 2). Recommendations were finalized through a town hall meeting with key stakeholders including patients, providers, researchers, policy makers, and representatives from healthcare settings (phase 3).

Results

Nine key elements from three areas emerged as the initial critical patient-reported elements to incorporate systematically into EHR—health behaviors (eg, exercise), psychosocial issues (eg, distress), and patient-centered factors (eg, demographics). Recommendations were also made regarding the frequency of collection ranging from a single assessment (eg, demographic characteristics), to annual assessment (eg, health behaviors), or more frequent (eg, patient goals).

Conclusions

There was strong stakeholder support for this initiative reflecting the perceived value of incorporating patient-reported elements into EHR. The next steps will include testing the feasibility of incorporating these elements into the EHR across diverse primary care settings.     

基于云计算的电子健康档案系统建设理念与实践

电子健康档案（Electronic Health Records,EHR）是人们在相关健康活动中直接形成的具有保存备查价值的电子化历史纪录,是医疗卫生管理和临床诊疗决策的重要依据。借助云计算理念和技术建设标准化的电子健康档案体系和系统,对于节约建设经费、降低维护成本、推进数据标准化、提高资源利用率具有巨大的应用价值。从云计算的网络特点和基础架构出发,依据电子健康档案系统的应用目标和发展方向,提出以居民健康为对象,在传递健康信息的同时,传递健康服务、传递计算能力的电子健康档案系统建设新理念,并据此探讨了标准化电子健康档案系统的建设方法和区域实践。     

Building the evidence-base to reduce electronic health record–related clinician burden

Clinicians face competing pressures of being clinically productive while using imperfect electronic health record (EHR) systems and maximizing face-to-face time with patients. EHR use is increasingly associated with clinician burnout and underscores the need for interventions to improve clinicians’ experiences. With an aim of addressing this need, we share evidence-based informatics approaches, pragmatic next steps, and future research directions to improve 3 of the highest contributors to EHR burden: (1) documentation, (2) chart review, and (3) inbox tasks. These approaches leverage speech recognition technologies, natural language processing, artificial intelligence, and redesign of EHR workflow and user interfaces. We also offer a perspective on how EHR vendors, healthcare system leaders, and policymakers all play an integral role while sharing responsibility in helping make evidence-based sociotechnical solutions available and easy to use.     

聚焦电子健康档案

电子健康档案与区域卫生信息网络在全世界范围内正在成为医疗卫生信息化的前沿阵地.从EMR与EHR的区别及其相互关系对电子健康档案的基本内涵加以辨析,并就目前国内外对电子健康档案研究和实践的现状进行介绍,阐明实现电子健康档案的意义,最后指出需要解决的关键问题.     

Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory

ObjectiveWe identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research.Materials and MethodsSince 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements.ResultsWe received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data.DiscussionBased on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries.ConclusionWe are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.     

基于健康档案的社区卫生信息系统研究与应用

探讨电子健康档案的建设标准,建设基于标准化电子健康档案（Electric Health Record,EHR）的区域协同医疗信息网络,研究建立基于电子病历与健康档案的区域协同医疗服务新模式,在区域内三级医院和社区卫生服务机构之间实现预约挂号、双向转诊、远程会诊、代理检验、急诊绿色通道等信息化医疗服务,大力优化区域医疗卫生资源配置。实现区域医疗卫生保健信息资源共享。     

Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?

Objective To validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data.Materials and Methods Subjects Children visiting any of 96 CHCs (N = 69 189) from 2011 to 2012. Analysis The authors measured correspondence (whether or not the visit was covered by Medicaid) between EHR coverage data and (i) reimbursement data and (ii) coverage data from Medicaid.Results Compared to reimbursement data and Medicaid coverage data, EHR coverage data had high agreement (87% and 95%, respectively), sensitivity (0.97 and 0.96), positive predictive value (0.88 and 0.98), but lower kappa statistics (0.32 and 0.49), specificity (0.27 and 0.60), and negative predictive value (0.66 and 0.45). These varied among clinics.Discussion/Conclusions EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings.     

电子健康档案的信息质量控制

电子健康档案是记录居民健康信息的系统化文件,是社区卫生服务中收集、记录社区居民健康信息的重要工具。本文论述电子健康档案的内容和范围,探讨电子健康档案质量控制的内涵和质量标准,提出电子健康档案信息质量控制的方法和对策。