Use and Satisfaction with Electronic Health Record by Primary Care Physicians in a Health District in Brazil

It is believed that Electronic Health Records (EHR) improve not only quality of care but also patient safety and health care savings. This seems to be true for developed countries but not necessarily in emerging economies. This paper examined the primary care physicians' satisfaction with a specific EHR in a health district of a major city in Brazil and describes how they are using it as well as its specific functions. A cross-sectional questionnaire survey with all physicians from all Community Health Centers of the 6th health district of the City of Fortaleza that were using HER was conducted. From the 111 subjects (100%), a total of 99 physicians answered the survey (89% response rate). For overall satisfaction with the EHR, 2 (2%) were satisfied, 50 (50.5%) were satisfied in part and 47 (47.5%) were not satisfied. For the functionalities, a proportion of correct answers (PCA) and an index of functionality usage (IFU) were developed. PCA and IFU were significantly correlated (p?相似文献   

社区卫生服务中电子病历质量控制体系及其应用效果的研究

目的 探索适用于社区卫生服务工作的电子病历质量控制体系,并通过实际应用验证该体系在提高和规范社区卫生服务电子病历质量方面的效果.方法 以前期社区卫生网络系统为基础,建立社区卫生服务电子病历质量控制体系,对北京市东城区从事社区卫生服务工作的全科医生按质量控制体系进行管理,并比较2006年下半年～2008年上半年电子病历质量的变化.结果 电子病历的优秀率从25.55%提高至32.48%,差异有统计学意义(χ2=10.677,P=0.001);合格率从86.19%提高至96.62%,差异有统计学意义(χ2=50.050,P=0.000).结论 电子病历质量控制体系的应用可以提高社区卫生服务医疗质量,规范社区诊疗行为.     

Implementation and Use of an Electronic Health Record within the Indian Health Service

Objectives

There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans.

Design

We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005.

Methods

The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR.

Results

The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient–doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05–8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records.

Conclusions

Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR.     

社区护理在电子健康档案中的应用模式研究

社区护理是社区保健工作的重要组成部分,承担着医院外的医疗预防、保健、康复护理工作。我国社区护理从业人员比率低,护理服务范围广,工作量大,这是造成目前社区护理工作无法有效开展的主要矛盾,电子健康档案的实施在一定程度上可以缓解这种矛盾。电子健康档案的应用是社区卫生服务发展的大势所趋,应尽快探索和发展出一条适合我国国情的社区护理模式。     

电子病历与医院住院流程再造的关系

目的 论述电子病历实现以患者为中心的医院住院流程管理思路和具体措施,探讨电子病历在医院住院流程再造中的促进作用.方法 实施电子病历,结合质量管理措施,围绕医院住院流程再造,研究电子病历和医院管理之间的关系.结果 采用结构化的电子病历有利于促进医院管理,提高临床管理质量,提升医院竞争力.结论 未来医院管理应努力结合电子病历的监控和管理,大力发展以患者为中心的结构化电子病历.     

电子病历与健康档案数据交换规范化的研究与应用

运用现代信息学理论和技术,以临床信息与病案书写规范为指南,并参照国家相关信息交换标准规范及国际标准化组织信息规范。针对电子病历与健康档案数据交换,采用可扩展标记语言（XML）技术,制定了《健康档案与病案的电子数据交换规范化应用指南》。并依据指南定义了电子病历与健康档案数据元素信息的XML结构文档,对提高医药卫生行业管理水平、信息安全传输和交换共享利用具有良好的应用价值。     

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.     

Proof-of-concept Design and Development of an EN13606-based Electronic Health Care Record Service

Objective

The authors present an Electronic Healthcare Record (EHR) server, designed and developed as a proof of concept of the revised prEN13606:2005 European standard concerning EHR communications.

Methods

The development of the server includes five modules: the libraries for the management of the standard reference model, for the demographic package and for the data types; the permanent storage module, built on a relational database; two communication interfaces through which the clients can send information or make queries; the XML (eXtensible Markup Language) process module; and the tools for the validation of the extracts managed, implemented on a defined XML-Schema.

Results

The server was subjected to four phases of trials, the first three with ad hoc test data and processes to ensure that each of the modules complied with its specifications and that the interaction between them provided the expected functionalities. The fourth used real extracts generated by other research groups for the additional purpose of testing the validity of the standard in real-world scenarios.

Conclusion

The acceptable performance of the server has made it possible to include it as a middleware service in a platform for the out-of-hospital follow-up and monitoring of patients with chronic heart disease which, at the present time, supports pilot projects and clinical trials for the evaluation of eHealth services.     

电子病历系统中患者死亡和出院时间一致性问题探讨

对电子病历系统中患者死亡时间和出院时间一致性的问题展开讨论.首先在文献检索和出院流程梳理的基础上,综述了患者死亡时间和出院时间的相关定义及确定标准,然后分析了两个时间保持一致性的要求,论述了两个时间能否做到一致和如何做到一致.阐述了电子病历系统中两个时间保持一致需要注意的问题,并提出需要进一步探讨和规范的问题.     

军人电子健康档案的总体设计与建设实践

介绍了医院结合医疗体制改革和总参一体化医疗服务建设所进行的军人电子健康档案建设的情况,分析了项目实施过程中面临的技术难题和解决方案,总结了健康档案建设存在的问题,并提出了相应的对策建议.     

电子病历书写时限质控体会

目的加强病历书写时限质控,提高病案质量,保障医疗安全。方法利用电子病历系统,对2012年1-12月份10595份运行病历的入院记录、首次病程记录、医嘱、手术记录的书写时限进行监控。结果经过一年多以来持续不断地周周检查、通报、整改、反馈,并落实奖惩措施,使病历书写及时率从56.25%提高到93.2%,明显改善。结论利用电子病历系统可以有效地监控病历完成时间,从而加强病历质量的环节管理,提高病历质量。     

医疗领域中的病案管理

病案管理是一门新兴的边缘科学,体制的建立与完善是病案管理的保证.掌握专业知识,提高医务人员的职业道德与法律意识,以保证患者的合法权利,也保护医疗人员的自身利益.开发病案信息资源,发展电子病案是医学领域里信息技术的一个飞跃.     

电子病历的质量与改进措施

目的通过对电子病历质量的缺陷进行分析,探讨提高病案质量的有效措施,切实维护各级医院的医疗安全。方法结合天津市肿瘤医院终末病历的质控结果及医疗安全不良事件发生特点进行统计分析。结果在2000份终末病历中存在的缺陷,以复制粘贴模板、病历内容欠缺及各种签名滞后为主,且与医疗安全不良事件发生呈正相关。结论实施有效的电子病案质量改进措施是维护医疗安全的重要保障。     

住院电子病历质量控制的内容和方法

随着医院电子病历系统的应用,电子病历的质量管理已成为医院管理的重要组成部分.本文针对住院电子病历系统的质量控制内容和方法进行了探讨.     

Disparities in Use of a Personal Health Record in a Managed Care Organization

Objective

Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity.

Design

The authors conducted a 2-year cohort study (2005-2007) assessing differences in rates of registration with KP.org, a component of the Kaiser Permanente electronic health record (EHR).

Measurements

At baseline, 1,777 25-59 year old Kaiser Permanente Georgia enrollees, who had not registered with KP.org, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and KP.org data were linked. Time to KP.org registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards.

Results

Of 1,777, 34.7% (616) registered with KP.org between Oct 2005 and Nov 2007. Median time to registering a KP.org account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549-0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294-2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels).

Conclusions

Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.     

电子病案与医疗质量控制

电子病历能实现法律法规对病案的要求;将有明确时限要求的30项内容作为病历质量的“单项否决”的条件。能加强病案的管理权限,以“今日提醒”的自动方式对主管医生提示和报警,做好病历环节质量的实时控制,保证病历质量的规范性。能规范疾病名称的书写,将抗生素的使用和院内感染的状况处于实时监控之中。电子签名保证电子病案的合法性及法律效应。     

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。     

电子病案信息与社区医疗共享

社区医疗服务中心能够为患者提供方便快捷的基本医疗服务,大力发展社区医疗服务是我国医疗改革的一项重要内容。三级医院的医疗信息不能与社区医疗共享,制约了社区医疗服务的信息化程度。电子病案的实施可以解决这一缺陷。     

举证责任倒置与病案质量的关系

目的探讨举证责任倒置与病案质量的法律关系。方法根据有关法律剖析病案质量的重要性。结果病案作为重要的医学信息源,不仅可为医疗、教学、科研提供宝贵资料,而且在法律、保险和医院管理等方面发挥着重要作用。尤其是在解决医疗纠纷、进行医疗事故鉴定、判定医务人员和医疗活动有无医疗过错等方面是一个最具有法律效力的书证。结论增强法律意识,提高病案质量对防止医疗纠纷的发生尤为重要。     

电子病案质量管理方法探讨

目的探讨现阶段电子病案质量管理的方法。方法分析电子病案的优势及应用中出现的问题,提出针对性的解决方案,进一步完善电子病案质量管理方法。结果以环节质控与终末质控相结合为基础,利用电子病案系统的特点,进行针对性重点监控、界定归档时限,以进一步完善电子病案质量管理方法,能有效提高电子病案质量,并保障信息安全。结论完善电子病案质量管理方法,做好管理模式的转型,对保证电子病案质量具有重要意义。