J Am Med Inform Assoc - Understanding differences in electronic health record (EHR) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care.

Tópicos

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Resumo

JECTIVE: Electronic health records (EHR) hold great promise for managing patient information in ways that improve healthcare delivery. Physicians differ, however, in their use of this health information technology (IT), and these differences are not well understood. The authors study the differences in individual physicians' EHR use patterns and identify perceptions of uncertainty as an important new variable in understanding EHR use.DESIGN: Qualitative study using semi-structured interviews and direct observation of physicians (n=28) working in a multispecialty outpatient care organization.MEASUREMENTS: We identified physicians' perceptions of uncertainty as an important variable in understanding differences in EHR use patterns. Drawing on theories from the medical and organizational literatures, we identified three categories of perceptions of uncertainty: reduction, absorption, and hybrid. We used an existing model of EHR use to categorize physician EHR use patterns as high, medium, and low based on degree of feature use, level of EHR-enabled communication, and frequency that EHR use patterns change.RESULTS: Physicians' perceptions of uncertainty were distinctly associated with their EHR use patterns. Uncertainty reductionists tended to exhibit high levels of EHR use, uncertainty absorbers tended to exhibit low levels of EHR use, and physicians demonstrating both perspectives of uncertainty (hybrids) tended to exhibit medium levels of EHR use.CONCLUSIONS: We find evidence linking physicians' perceptions of uncertainty with EHR use patterns. Study findings have implications for health IT research, practice, and policy, particularly in terms of impacting health IT design and implementation efforts in ways that consider differences in physicians' perceptions of uncertainty.

Resumo Limpo

jectiv electron health record ehr hold great promis manag patient inform way improv healthcar deliveri physician differ howev use health inform technolog differ well understood author studi differ individu physician ehr use pattern identifi percept uncertainti import new variabl understand ehr usedesign qualit studi use semistructur interview direct observ physician n work multispecialti outpati care organizationmeasur identifi physician percept uncertainti import variabl understand differ ehr use pattern draw theori medic organiz literatur identifi three categori percept uncertainti reduct absorpt hybrid use exist model ehr use categor physician ehr use pattern high medium low base degre featur use level ehren communic frequenc ehr use pattern changeresult physician percept uncertainti distinct associ ehr use pattern uncertainti reductionist tend exhibit high level ehr use uncertainti absorb tend exhibit low level ehr use physician demonstr perspect uncertainti hybrid tend exhibit medium level ehr useconclus find evid link physician percept uncertainti ehr use pattern studi find implic health research practic polici particular term impact health design implement effort way consid differ physician percept uncertainti

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