Background

Research suggests that capturing the benefits of electronic health records (EHR) requires systematic and ongoing optimization of technology configuration and use after implementation. However, little is known about EHR optimization in a hospital context.

Objective

To explore the issues and challenges involved in organizing and managing a systematic user-driven EHR optimization program.

Methods

A longitudinal case study of an EHR optimization program launched in two large Danish hospital systems was undertaken. It involved interviewing 28 key managers, clinicians and IT staff, participating in formal and informal meetings, and reviewing policy documents, meeting minutes, teaching materials and other relevant documents.

Findings

The two hospital systems are struggling to find the best way to organize and manage the optimization program. So far, the program has been a mixed success. Involving clinicians in EHR optimization poses serious dilemmas for hospital managers, who must manage two related tensions: between standardization and adaptation, and between centralized control and local autonomy.

Conclusion

The findings highlight the significant challenges in designing a successful EHR optimization program and underscore the importance of developing more sophisticated strategies for clinical standardization and innovation.

中文翻译：

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用户驱动的EHR优化中的挑战：丹麦大型Epic实施案例研究

背景

研究表明，要获取电子病历（EHR）的好处，需要在实施后对技术配置和使用进行系统且持续的优化。但是，对于医院环境中的EHR优化知之甚少。

目的

探索组织和管理系统的，用户驱动的EHR优化程序所涉及的问题和挑战。

方法

对在两个丹麦大型医院系统中启动的EHR优化计划进行了纵向案例研究。它涉及采访28位主要经理，临床医生和IT人员，参加正式和非正式会议，并审核政策文件，会议记录，教材和其他相关文件。

发现

这两个医院系统都在努力寻找组织和管理优化程序的最佳方法。到目前为止，该计划取得了不同的成功。让临床医生参与EHR优化会给医院管理人员带来严重的困境，他们必须处理两个相关的紧张关系：标准化与适应之间，集中控制与地方自治之间。

结论

研究结果突显了设计成功的EHR优化计划所面临的重大挑战，并强调了为临床标准化和创新开发更复杂策略的重要性。