Originales
Modificaciones en las perspectivas de los médicos sobre el registro médico electrónico: investigación cualitativa longitudinal
Changes in physicians’ attitudes to computerized ambulatory medical record systems: a longitudinal qualitative study
Adriana Ruth Dawidowskia,
, Luzia Tosellia, Daniel Roberto Lunaa, Pablo Fernando Obertia, María Aracelli Sotob, Fernán González Bernaldo de Quirósa
Autor para correspondencia
adriana.dawidowski@hospitalitaliano.org.ar
Correspondencia: Adriana Dawidowski. Hospital Italiano de Buenos Aires. Plan de Salud. Epidemiología. Gascón, 450. C1181ACH Buenos Aires. Argentina.
Correspondencia: Adriana Dawidowski. Hospital Italiano de Buenos Aires. Plan de Salud. Epidemiología. Gascón, 450. C1181ACH Buenos Aires. Argentina.
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Hospital Italiano de Buenos Aires. Plan de Salud. Epidemiología. Gascón, 450. C1181ACH Buenos Aires. Argentina." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Changes in physicians’ attitudes to computerized ambulatory medical record systems: a longitudinal qualitative study" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-04-10" "fechaAceptado" => "2007-02-07" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec14034" "palabras" => array:5 [ 0 => "Actitud hacia los ordenadores" 1 => "Actitud del personal de salud" 2 => "Sistemas de registros médicos computarizados" 3 => "Investigación cualitativa" 4 => "Relaciones profesional-paciente" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec14033" "palabras" => array:5 [ 0 => "Attitude to computers" 1 => "Attitude of health personnel" 2 => "Computerized medical records systems" 3 => "Qualitative research" 4 => "Physician-patient relations" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Conocer las creencias de los médicos sobre un registro médico electrónico para la atención ambulatoria en diferentes etapas del proceso de implementación del sistema.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Investigación cualitativa longitudinal basada en entrevistas en profundidad (desde julio de 2001 hasta diciembre de 2003), desarrolladas en el Hospital Italiano de Buenos Aires (Argentina). Se entrevistó a 20 cardiólogos de atención ambulatoria con perfiles profesionales diversos (muestreo intencional) antes, durante y al finalizar la implementación del sistema (10 entrevistas por etapa). El análisis fue realizado por 2 investigadores independientes y las categorías refinadas conjuntamente.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Antes y durante la primera etapa de la implementación los médicos esperaban que el sistema mejorara los procesos administrativos de la atención y la disponibilidad de los datos individuales que cada uno había registrado en consultas anteriores, pero no imaginaban que la información colectiva pudiera modificar los aspectos médicos de la atención. Al finalizarla implementación, en cambio, percibieron que el sistema les permitía acceder a una visión integral del paciente que modificaba el desempeño profesional. Durante la implementación, los médicos opusieron el contacto con el paciente a la interacción con el ordenador, oposición que les impide categorizar su uso como parte del acto médico y considerar los datos del sistema como signos directos del paciente.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Con la implementación, los médicos modificaron su perspectiva sobre el registro médico electrónico, llegando a percibirlo como un auxiliar para la práctica médica. El valor que se asigna al sistema depende de su relevancia dentro del marco institucional.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To explore physicians’ beliefs about a computerized ambulatory medical record system at different stages of its implementation.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a longitudinal qualitative in-depth interview study (July 2001 to December 2003) in the Hospital Italiano, Buenos Aires, Argentina. Semi-structured interviews were conducted in 20 primary care cardiologists purposively selected before, during and afterthe system's implementation process (10 interviews perstage). The interviews were independently analyzed by 2 researchers, who jointly designed an agreed category list.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Both before and during the first stage of the implementation process, the physicians expected that that the system would improve healthcare-related administration and increase accessibility to individual data. However, they did not foresee that the system's shared information could modify the clinical aspects of patient care. By the end of the implementation process, the physicians realized that the system provided them with a broader perspective on their patients, which in turn improved their own professional performance. Throughout the implementation, the physicians were against using the computer while the patient was present. This opposition prevented them from regarding the system as part of the medical consultation and from considering data from the system as direct patient-related signs.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The system's implementation modified the physicians’ views on computerized ambulatory medical records, as they eventually considered them as an ancillary tool to clinical activity. The value assigned to the system depends on its relevance within the institutional framework.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13110442
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