Izivivinyo Nezinsizi ze-EMR kanye ne-EHRs
Amarekhodi wezokwelapha ngamaphepha aqoshiwe abhalwe ngokuzenzakalelayo anikeze amarekhodi wezokwelapha (EMRs). Nakuba amarekhodi wezokwelapha ze-digital ayelokhu ehamba iminyaka okungenani engu-30, ukutshalwa kwezimali okuphawulekayo kule minyaka eyishumi edlule kuye kwaholela ekuphatheni kwedatha nokufinyeleleka okwakukade kungatholakali. Ukushesha kwezinto ezintsha kanye nokuthuthukiswa kwe-EMRs kuyanda, noma kunjalo, kunamabango amaningana okumelwe anqobe.
Ukuqaliswa kwezinhlelo ezintsha zedatha yezokwelapha sekutholwe ukugxeka kwabaphephandaba bezintatheli kanye nabahlaziyi ngokubonakala kokuntuleka kokuphendula nokunika amandla.
EHR vs. EMR
Ama-acronyms amabili-i-EHR ne-EMR-avame ukusetshenziswa ngokungafani. Kodwa njengoba iHhovisi loMxhumanisi Kazwelonke Wezobuchwepheshe WezeMpilo (i-ONC) liphawula, kukhona umehluko phakathi kwamarekhodi ezempilo kagesi (EHRs) nama-EMRs. Ama-EMR ayedlule ama-EHR futhi ahloselwe ukuthi umtholampilo asebenzise kuphela. Ama-EHR azama ukuqhubeka futhi ahlanganise uhlaka olubanzi lwemininingwane kune-EMRs.
Ukusetshenziswa okunenjongo-isethi yamazinga okumele aqiniseke ukuthi ama-dollar ezempilo asetshenziselwa ama-EHR aphumela emiphumeleni ekhiqizayo-ngokuyinhloko izigunyazo zokuthi i-EHR ikwazi ukusebenzisana. Lesi siqondiso sidinga ukuvula idatha yezempilo nokuxhuma izinhlelo ezahlukene ukudala imodeli "eminingi kuya eziningi" (ngokuphambene nomdwebo othi "iphuzu kuya iphuzu") kwakusho ukwandisa usizo lomuntu siqu wezokwelapha.
Kodwa-ke, uFred Trotter, intatheli yezintatheli zezempilo kanye nomlobi, uthi i-EHR ayikakwazi ukushintshanisa idatha nokuxhumana, ngakho-ke uhlelo lwezokunakekelwa kwempilo lwaseMelika lungase lube khona ngenkathi ye-EMRs.
Yini evimbela uhlelo lwezempilo lokusebenzisana?
UDkt. Karen DeSalvo, owayengumxhumanisi wezeMpilo wezoLwazi lwezeMpilo kaZwelonke, wabhala mayelana nezikhalazo "zokuvimbela ulwazi lwezempilo." Lo mkhuba uphazamisa ukushintshaniswa nokusetshenziswa kolwazi lwezempilo lwe-elekthronikhi futhi kungenye yezingqinamba zokusebenzisana.
Ngesikhathi abameli abaningi bezempilo be-digital bexhasa umgomo wokwabelana ngolwazi okungenzeka ukuthi uthuthukise ukunakekelwa kwezokwelapha futhi ulondoloze imali, u-DeSalvo uthi, "abanye ababambiqhaza emkhakheni wezokwelapha kanye nezempilo ze-IT banezikhuthazo eziqinile zokulawula ulwazi lwezempilo lwe-elekthronikhi."
Ngo-Ephreli 2015, i-ONC ithumele umbiko kuCongress ngolwazi lokuvimbela, futhi abalobi bezenzo ezihlongozwayo ezingavimbela lo mkhuba, futhi kuthiwa kufanele kube nokukhanya okuthe xaxa ezimakethe ze-IT zezempilo.
Ucwaningo lukazwelonke olwenziwa uJulia Adler-Milstein no-Eric Pfeifer we-University of Michigan Izikole Zolwazi kanye Nempilo Yomphakathi kubonise ukuthi ukuvimbela ulwazi kuhlala kusakazeke kuze kube manje. Abaphendulile babike ukuthi abathengisi, izibhedlela nezinhlelo zezempilo zivame ukubandakanya ulwazi lokuvimba. Ukusebenzisana okulinganiselwe kwemikhiqizo kwakungenye yefomu ezivame kakhulu kulo mkhuba phakathi kwabadayisi. Izibhedlela kanye nezinhlelo zezempilo, ngakolunye uhlangothi, zazivame ukutholakala ukunikeza ukwelashwa okukhethekile kunhlobo oluthile lwe-EHR nabahlinzeki abaphoqelelwe ukuba bayamukele. Abaphenduli nabo babone izibhedlela ezilawula ukugeleza kweziguli ngokungabelani ngolwazi lwabo ngokuvulekile.
Ngaphandle kwalokho, ukugqugquzelwa kwemikhuba enjalo kwakuyisifiso sokwandisa imali. U-Adler-Milstein noPfeifer bakholelwa ukuthi ulwazi oluvimbayo kufanele lube mthethweni, oluzobandakanya ukungenisa umthetho omusha endaweni yokushintshaniswa kwedatha nokwabelana.
Enye imingcele ekhonjiwe ekusebenzisaneni okuphumelelayo kwe-EMRs ingxube eyinkimbinkimbi yezindaba zobuchwepheshe nokusebenzisana kwenqubomgomo. I-Trotter icela izibhedlela ukuthi zenze indima ezinikezele ekubhekaneni nalezi zinkinga ezikhethekile kakhulu.
Kuzo zonke, ukusebenzisana kuyinto inselele. Abaningi bezokunakekelwa kwempilo bakholelwa ukuthi izithiyo ekusetshenzisweni kwayo azikasuswanga nokho naphezu kwazo zonke izintshisekelo zokuqala kanye nezinsiza ezibekiwe kule phrojekthi.
Ukuhamba kwe-EMRs
Ukuguqulwa kwedatha yomuntu siqu yompilo kungomunye umqondo obalulekile ohlobene nokudala ukulinganisa phakathi kwe-syntax esetshenziselwa ukwakha amarekhodi ezempilo kanye nokukwazi ukuhambisa kalula le datha kuzo zonke izinhlelo ezingafani. Ucwaningo oluningi lubonise ukuthi idatha ephathekayo futhi ephathekayo kalula ingathuthukisa kakhulu izinsizakalo zokunakekelwa kwezempilo futhi ithuthukise ukunakekelwa kweziguli. Kodwa-ke, ukuphatheka kwe-EMRs kuyinselele engakaxazululwa okwamanje kanti futhi kusadingeka ukuthi igcwaliswe ukuze ivikele uhlelo lokunakekela impilo oludidiyelwe.
Ukushintshwa okuphephile nokuphephile kolwazi lwezempilo yedijithali kuhlala enye yezinto ezibalulekile zokunyakaza kwezempilo kwe-digital. Abacwaningi baseNdiya abahlola ukuqaliswa kwe-EHR emazweni asathuthukile baye basikisela ukuthi isitoreji sefu, ukuvikelwa kwephasiwedi, nokubethelwa konke kubeka izinyathelo zokuhlinzeka ngempilo abahlinzeki bezempilo abangathatha ukwenza i-EHR ephathekayo ivikeleke nakakhulu. Okunye ukuphulwa kokuphepha nokuhlukunyezwa kokuziphatha kuye kwarekhodwa futhi lezi zikhathi ezithile ziye zafakazela ukusizwa kwama-EHRs.
Ukuvala izikhala zezempilo ze-IT
Ukuze kuthuthukiswe ukwabelana ngolwazi lwezempilo, ngoJulayi 28, 2015, i-ONC yamemezela ngaphezu kwamaRandi ayizigidi ezingu-38 emiklomelo yesibonelelo ezinhlanganweni ezingu-20 ezivela emazweni angu-19 ezweni lonke. Into eyodwa amaholo abhekeke ukuthi basebenze ngayo okwandisa ukuhlanganiswa kolwazi lwezempilo. Uhlelo lwezempilo lomphakathi lokufunda kontanga lwabikezelwa ukusiza imiphakathi ithuthukise i-aggregation yedatha, ukuphatheka kwedatha kanye nokuhlaziywa kwedatha, bonke benomgomo wokufeza imiphumela engcono kanye nokusebenzisa kahle ukunakekelwa kwempilo.
Ezinye izinhlelo ziye zafakwa ukuze zibandakanye iziguli futhi zithuthukise ukunakekelwa kokunakekelwa, njenge-Medicare ne-Medicaid EHR Incentive Programs. Lezi zinhlelo zikhuthaza ukushintshaniswa okuphephile kolwazi lwezempilo. Babuye bakhuthaze ukufinyeleleka kwesiguli kumarekhodi namathuluzi e-elektroniki ukuze bakwazi ukuxhumana nabahlinzeki bezempilo. Inhloso yonke yalolu hlelo ukunciphisa ukungalingani kwezempilo futhi unikeze ukunakekelwa okufanelekayo ngokwemvelo ngosizo lwezobuchwepheshe. Ukuhlaziywa kwamuva koHlelo Lokuvuselela EHR nguMnyango wezeMpilo we-Informatics kanye nokuPhathwa kweLwazi lweKholeji yaseSt. Scholastica kubonise ukuthi kwenziwa intuthuko enkulu. Kodwa-ke, ukuze ube iklayenti eligxile kakhulu futhi uthuthukise imiphumela yokunakekela bonke, ukubandakanyeka komsebenzisi kudinga ukunakwa okwengeziwe.
> Imithombo
> Adler-Milstein J, Pfeifer E. Ukuvimbela Ulwazi: Ingabe Kuyenzeka Futhi Yiziphi Izinqubo Zenqubomgomo Ezingayikhetha? . I-Milbank Quarterly . 2017; (1): 117-135
> Ozair FF, Jamshed N, Sharma A, Aggarwal P. Izinkinga eziphathelene nokuziphatha ezimweni zamarekhodi ezempilo: Ukubuka konke okujwayelekile. Izindlela zokuPhenywa Kwezokwelapha . 2015; 6 (2): 73-76
> Terry K. Usalinde: kungani ukusebenzisana kwe-EHR kusalokhu kungumgomo ongenakuqhathaniswa. Umnotho Wezokwelapha . 2017; (11): 14-19.
> I-Trotter F. Yini Engayisebenzisa Ngenzuzo Ukufunda Ku-Healthcare.gov ?. I-Health Care Blog , Mashi 2, 2015. http://thehealthcareblog.com/blog/2015/03/02/what-can-meaningful-use-learn-from-healthcare-gov
> Watters A, Bergstrom A, Sandefer R. Ukuzibandakanya kweziguli nokusetshenziswa okunenjongo: Ukuhlola umthelela wohlelo lokugqugquzela u-EHR ngamakhono amasiko ekunakekelweni kwezempilo. I-Journal Yokuhlukahluka Kwezenzo . 2016; 23 (3): 114-120.