The electronic health record (EHR) is an important part of the effort to improve health care and reduce costs in the United States. Primary care providers, among the largest group of caregivers in the nation, often experience difficulty with implementation and utilization of EHRs. Efforts to enhance the provider's effectiveness in the use of the EHR should result in improved patient outcomes as well as decreasing the overall cost of health care. Guided by the diffusion of innovation theory, this project was initiated to develop a plan for improved usage of the EHR in a primary care setting. A survey and observations were used to better understand how the providers and staff were using the EHR. Observations and a survey of 11 participants were completed. The observations utilizing a mock patient revealed issues related to the usability of screen information, information availability, and user preference for documentation. The mock patient scenario took 25-35 minutes, on average, to complete. All participants stated they had stayed late to input information on actual clinic patients or to clarify their documentation. The same 11 participants completed the Primary Care Information Project (PCIP) Post-Electronic Health Record Implementation: Survey of Providers responses. Descriptive statistics were used to analyze the results. Most participants indicated that the screen font was difficult to read (72.7%), they had difficulty using the EHR (72.8%) and were not satisfied with its use (63.6%). The project recommendations include working with the vendor to improve information access and ongoing training. Improvements to the EHR should support social change by improving access to information at the point of care, enhancing quality treatment and improving patient care outcomes.

såväl vårdens lagstiftning som i utveckling av vården får patienten allt mer central ställning och roll. Ur ett patientperspektiv pekar dock uppföljningar av lagstiftning som reglerar samverkan vid utskrivning från sluten hälso- och sjukvård på bristande kunskapsläge på nationell nivå. Syftet med denna studie var att genom patientens egen berättelse söka insikter om upplevelser av utskrivningsprocessen från somatisk sluten hälso- och sjukvård och tiden efter, där behov funnits av fortsatt vård och omsorg efter utskrivning. Syftet var också att söka förståelse för huruvida Appreciative Inquiry kan bidra till insikter till ständiga förbättringar ur ett patientperspektiv. Med kvalitativ design och narrativ ansats genomfördes nio värdeskapande intervjuer med vuxna personer som vårdats på sjukhus 1 januari 2018. Dessa personer hade även behov av vård och/eller omsorg efter utskrivning. Intervjuguiden innehöll två huvudfrågor; “Berätta din berättelse om när du senast låg inne på sjukhus och tiden efter när du kom hem” och “Kan du berätta om en situation eller händelse som sticker ut som fungerade riktigt bra?”. Släktskapsdiagram grupperade och sorterade intervjuernas innehåll varvid fem indikatorer identifierades som viktiga i utskrivningsprocessen; Bemötande, att bli Lyssnad på, vara Informerad, uppleva att det Klaffar och upplevelse av Delaktighet. Ålder, allvarlighetsgrad på sjukdom eller behovsnivå av kommunal vård och omsorg efter utskrivning verkar inte vara faktorer som påverkar vad som är viktigt i samband med utskrivning från sluten vård. Befintlig lagstiftad process harmoniserar delvis med patientens uttryckta behov av vad som är viktigt. Patientens egen berättelse ingår i personcentrerat förhållningssätt där Appreciative Inquirys grundfilosofi såväl som värdeskapande verktyg kan bidra till processutveckling. / In both healthcare legislation and in the development of healthcare, the role of the patient is obtaining an increasingly central position. However, from a patient perspective, there appears to be a lack of knowledge at the national level about what is important during the discharge process from the hospital. The study aimed to gain insights through the patient's own story about experiences of the discharge process from closed somatic health care, including the time following discharge when additional care was needed. The purpose was also to develop understanding about in what ways the Appreciative Inquiry method can contribute to insights about the patients perspective that could serve continuous improvements. With qualitative design, and a narrative approach based on appreciative inquiry, nine interviews were conducted with adults who had been hospitalized after January 1th 2018. These individuals were also in need for care after discharge. The interview guide contained two main questions; “Tell me your story of when you were last hospitalized and the time after when you came home” and “ Can you tell me about a certain situation or event which stands out, that worked really well?”. The content from the interviews was sorted and categorized using a relationship diagram that identified five indicators as important to the discharge process; Empathetic response, being listened to, being informed, experiencing flow and experience of participation. Age, severity of illness or level of need for municipal care after discharge does not appear to be factors of importance in context of the discharge process from hospitalized care. Existing legislative process are partially in harmony with the needs expressed by patients about what is important. The patient’s own story is part of the person-centered approach where Appreciative Inquiry’s philosophy, as well as its value-creating tools, can contribute to process development. / <p>2020-06-26</p>