背景:NORDeHEALTH项目研究爱沙尼亚患者可访问的电子健康记录(PAEHRs),芬兰,挪威,和瑞典。这种国家比较需要分析这些服务的社会技术背景。尽管过去曾对PAEHR服务进行过社会技术分析,尚未制定专门针对深入跨国分析的框架。
目的:本研究旨在开发和评估一种PAEHRs的社会技术分析方法,该方法促进了Sittig和Singh首次提出的eHealth解决方案的社会技术分析框架。系列文章的第一篇文章介绍了该方法的开发以及对实现PAEHR访问和使用的上下文因素的跨国比较。
方法:在与国际利益相关者的一系列研讨会中,对社会技术分析框架的维度进行了彻底讨论和扩展,都是专注于PAEHR的eHealth研究人员。所有国家都派代表参加了工作组,以确保涵盖重要的国家观点。编制了一份电子表格,其中包含与所研究的服务和社会技术框架的各个层面有关的相关问题,并分发给4个参与国,项目参与者研究了各种国家来源,为10个社会技术维度的比较提供相关数据。
结果:总计,在Sittig和Singh的方法中增加了3个维度,以将临床内容与PAEHRs的特征和功能分开,并展示了不同国家在国家和区域指导医疗保健以及信息和通信技术发展方面的基本特征。最终框架包含以下维度:元数据;硬件和软件计算基础设施;特征和功能;与患者共享的临床内容;人机界面;人员;工作流程和沟通;医疗保健组织的内部政策,程序,和文化;国家规则,法规,和激励措施;系统测量和监测;以及医疗保健系统背景。研究期间增加的维度主要涉及跨国比较所需的背景信息。在比较国家中发现了一些相似之处,特别是关于硬件和软件计算基础设施。所有国家都有,例如,一个国家接入点,自动为患者提供PAEHR。大多数差异可以在医疗保健系统上下文维度中识别。一个重要的区别涉及信息和通信技术发展的管理,其中不同的级别(状态,区域,和市政当局)在不同的国家负责。
结论:这是首次对患者获取电子健康记录的服务进行大规模的国际社会技术分析;这项研究比较了爱沙尼亚的服务,芬兰,挪威,和瑞典。开发了一种用于这种分析的方法,并提出了这种方法,以便在其他国家背景下进行比较研究,以便将来对PAEHR进行实施和评估。
BACKGROUND: The NORDeHEALTH project studies patient-accessible electronic health records (PAEHRs) in Estonia, Finland, Norway, and Sweden. Such country comparisons require an analysis of the sociotechnical context of these services. Although sociotechnical analyses of PAEHR services have been carried out in the past, a framework specifically tailored to in-depth cross-country analysis has not been developed.
OBJECTIVE: This study aims to develop and evaluate a method for a sociotechnical analysis of PAEHRs that advances a framework for sociotechnical analysis of eHealth solutions first presented by Sittig and Singh. This first article in a series presents the development of the method and a cross-country comparison of the contextual factors that enable PAEHR access and use.
METHODS: The dimensions of the framework for sociotechnical analysis were thoroughly discussed and extended in a series of workshops with international stakeholders, all being eHealth researchers focusing on PAEHRs. All countries were represented in the working group to make sure that important national perspectives were covered. A spreadsheet with relevant questions related to the studied services and the various dimensions of the sociotechnical framework was constructed and distributed to the 4 participating countries, and the project participants researched various national sources to provide the relevant data for the comparisons in the 10 sociotechnical dimensions.
RESULTS: In total, 3 dimensions were added to the methodology of Sittig and Singh to separate clinical content from features and functions of PAEHRs and demonstrate basic characteristics of the different countries regarding national and regional steering of health care and information and communications technology developments. The final framework contained the following dimensions: metadata; hardware and software computing infrastructure; features and functions; clinical content shared with patients; human-computer interface; people; workflow and communication; the health care organization\'s internal policies, procedures, and culture; national rules, regulations, and incentives; system measurement and monitoring; and health care system context. The dimensions added during the study mostly concerned background information needed for cross-country comparisons in particular. Several similarities were identified among the compared countries, especially regarding hardware and software computing infrastructure. All countries had, for example, one national access point, and patients are provided a PAEHR automatically. Most of the differences could be identified in the health care system context dimension. One important difference concerned the governing of information and communications technology development, where different levels (state, region, and municipality) were responsible in different countries.
CONCLUSIONS: This is the first large-scale international sociotechnical analysis of services for patients to access their electronic health records; this study compared services in Estonia, Finland, Norway, and Sweden. A methodology for such an analysis was developed and is presented to enable comparison studies in other national contexts to enable future implementations and evaluations of PAEHRs.