Abstract：
OBJECTIVE: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability.
METHODS: Cross-sectional study.
METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer\'s V.
RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for \'interactive patient education\' (37·3%) or \'home monitoring and self-testing of chronic conditions\' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer\'s V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer\'s V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity.
CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.
METHODS: Cross-sectional study.
METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer\'s V.
RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for \'interactive patient education\' (37·3%) or \'home monitoring and self-testing of chronic conditions\' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer\'s V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer\'s V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity.
CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.
摘要：
目的：电子医疗记录（EHR）系统的功能以及来自不同环境的初级保健医师（PCP）使用它们的频率存在差异。我们的目的是研究与PCP日常使用EHR相关的因素，表征PCP可用的EHR功能，并确定实践设置对功能可用性的影响。
方法：横断面研究。
方法：来自20个国家的PCP在2020年6月至9月间完成了横断面在线调查。保留了报告EHR使用频率的反应。日常EHR使用与PCP和实践因素之间的关联(国家，城市化，和数字成熟度)使用多变量逻辑回归分析进行探索。使用Cramer的V.
结果：在接受调查的1605个PCP中，有1520个（94·7％）的响应被保留。91·2%的PCP报告每天使用EHR。每天使用EHR与PCP每周工作>28小时相关，有多年使用EHR的经验，就业国家,更高的数字成熟度。EHRs与进入有关的特征，大多数PCP都可以检索数据。很少有PCP报告可以使用“交互式患者教育”（37·3％）或“慢性病的家庭监测和自我检测”（34·3％）的工具。实践国家与所有EHR功能的可用性相关（CramerV范围：0·2-0·6），特别是有工具使患者能够进入EHR（CramerV：0·6，P<0.0001）。随着数字成熟度的提高，观察到EHRs功能的功能可用性更高。
结论：供患者使用的EHR特征在各个国家和数字成熟度级别中并不常见。系统层面的研究是必要的，以确定阻碍在初级保健中实施EHR功能的国家特定障碍，特别是EHR的特征，使患者能够与EHR互动，制定改善系统范围内EHR使用的策略。
方法：横断面研究。
方法：来自20个国家的PCP在2020年6月至9月间完成了横断面在线调查。保留了报告EHR使用频率的反应。日常EHR使用与PCP和实践因素之间的关联(国家，城市化，和数字成熟度)使用多变量逻辑回归分析进行探索。使用Cramer的V.
结果：在接受调查的1605个PCP中，有1520个（94·7％）的响应被保留。91·2%的PCP报告每天使用EHR。每天使用EHR与PCP每周工作>28小时相关，有多年使用EHR的经验，就业国家,更高的数字成熟度。EHRs与进入有关的特征，大多数PCP都可以检索数据。很少有PCP报告可以使用“交互式患者教育”（37·3％）或“慢性病的家庭监测和自我检测”（34·3％）的工具。实践国家与所有EHR功能的可用性相关（CramerV范围：0·2-0·6），特别是有工具使患者能够进入EHR（CramerV：0·6，P<0.0001）。随着数字成熟度的提高，观察到EHRs功能的功能可用性更高。
结论：供患者使用的EHR特征在各个国家和数字成熟度级别中并不常见。系统层面的研究是必要的，以确定阻碍在初级保健中实施EHR功能的国家特定障碍，特别是EHR的特征，使患者能够与EHR互动，制定改善系统范围内EHR使用的策略。
