How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings Nancy M Lorenzi , Angelina Kouroubali , Don E Detmer and Meryl Bloomrosen BMC Medical Informatics and Decision Making 2009, Published: 23 February 2009
Multiple visions for the EHR
Visionaries have predicted that widespread availability of EHRs in ambulatory care settings can improve the quality of care, improve communications with patients, reduce transcription costs, provide clinicians with easier cross-coverage, and support decision-making by clinicians and patients [9-13]. There are multiple definitions of an EHR. Several examples include:
先講 EHR 本質在 臨床流程 !
The Healthcare Information and Management Systems Society (HIMSS) defined EHR as "...a longitudinal electronic record of patient health information produced by encounters in one or more care settings.
>Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.
The EHR automates and streamlines the clinician's workflow.
所以要獨立 Server, 不只是用現有資源組個 view.
The EHR has the ability to independently generate a complete record of a clinical patient encounter, as well as supporting other care-related activities such as decision support, quality management, and clinical reporting [19].
最後，還是要講「改變」是一定要面對的
Introduction to change as a key factor in EHR implementation
Practical experience has shown that change is an ongoing process of anticipated, emergent and opportunity-based events that have a fluid and unpredictable nature. People who work together closely on a daily basis are the individuals who initiate change in smaller ambulatory practice environments. Resistance in this type of environment is often temporary, as there is a tendency for smaller organizations to seek a steady equilibrium [30]. Nevertheless, change management cannot address the external financial and policy barriers mentioned previously. Additionally, the complex issues related to privacy, security and confidentially are beyond the scope of this paper. However, once a decision is made to implement EHRs, managing change is invaluable to the process.
Lessons of change management from larger institutions cannot be easily or directly applied to unique ambulatory healthcare practice settings. The cultures that comprise healthcare settings (e.g., physician offices, hospitals, surgery suites, etc.) add to the complexity of change efforts. The nature and the organizational variation of physician practices require an approach to change that is flexible. The smaller ambulatory practice change environment emphasizes individual enthusiasm, commitment, and personal ability of individuals to share information and to cooperate. Individuals within such practices who have adequate technical knowledge and skills are in a better position to assist and support the entire office during an EHR implementation than are such individuals in much larger environments. Small ambulatory practices place a greater emphasis on managing relationships at the core of the new behavior that the practice wishes to instill [31]. This view of change as internally generated is relevant in ambulatory physician offices. While most physician practice leaders can find the financial resources to support an EHR, the requirements and decisions for the appropriate EHR system come directly from the entire practice.
To be successful, physician practice groups need to place attention on the practical aspects of EHR implementation. ...後面講到醫師就覺得任重道遠了。
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