An Individual Pilot Study To The Promotion Of Village Doctors Using Electronic Health Records

Objective：To explore the appropriate and worthy to promotion model of the application ofelectronic health record (EHR) in rural community health service (CHS) in depressedareas, provide a reference for the application of EHR in rural community healthservices in depressed areas.Methods：10townships in Chongyi County were chosen as research sites. Two similarCommunity Health Service stations (CHSS) were chose from each of these10townships. One of these was randomly allocated to the intervention group (totally10CHHSS) and one to the control group (totally10CHHSS). Individualinterventions were conducted to trial group, but no intervention with control stations,parallel observation. The individual interventions were field facilitation visits once amonth. The baseline evaluation was conducted in October2011. The follow upevaluation was conducted in March2012. There were four evaluation methods:An assessment of the basic conditions of each CHS stationA questionnaire of the village doctors about the KAP of EHR, satisfaction ofEHR and individual interview.Asurvey of rural residentsTrace survey data and baseline survey data was compared by with groups of time andbetween groups, in order to evaluate the effect of the individual intervention.Results：The basic condition of CHSS: In trial group, the average training days of pervillage doctors was12.8days, an increase of7.3days (t=-2.714, P=0.014). Incontrol group, the average training day of per village doctors was10.7days, anincrease of5.8days, but there was no significant change.Village doctors’"KAP" situation and satisfaction about EHR:①After theexperiment,70%of village doctors in trial group felt that EHR could improve theirefficiency, an increase of40%(Z=-1.457, P=0.145).60%of those in control sites thought it would improve efficiency an increase of20%(Z=-0.959, P=0.337);②40%of trial doctors felt that they were unskilled (decrease by30%)(P=0.370)compared to50%of control doctors (increase by10%)(P=1.000);③70%of village doctors intrial group often entered public health information an increase of50%frombaseline(Z=-2.189, P=0.029). This compares with50%in control group (a20%increase)(Z=-1.076, P=0.282);④Before the experiment,10.0%of village doctors intrial group and20.0%of village doctors in control group often input diagnosis andtreatment information immediately, after the experiment, the proportion of trialgroup(Z=-2.091, P=0.036) and control group was both increased to50.0%，but therewas no significant difference in control group (Z=-1.699, P=0.089)；⑤Thesatisfaction average score of trial group about EHR was82.20±6.16average score ofcontrol group was69.70±12.88(t=2.768, P=0.016).Residents’ satisfaction:①Dissatisfaction with the notice of price oftreatment decreased from80.0to63.0%in trial group(Z=-3.176, P=0.001), while itincreased in control group from54.0%to67.0%(Z=-3.400, P=0.001);②Theproportion never divulging the condition of another patient increased in trial groupfrom53.5%to80.5%(Z=-6.323, P=0.000), The proportion of control group wasincreas3ed from52.50%to63.50%(Z=-2.441, P=0.015);③The proportion beingalways or frequently asked to choose their own referral agency increased from60%to84%in trial group(Z=-1.185, P=0.236) and from71%to88%in the controlgroup(Z=-3.356, P=0.001);④The proportion in trial group who reported that theirrecords could be easily located increased from57.5%to87.5%(Z=-5.498, P=0.000).However there was no significant change in control group with70.5%(Z=-0.245,P=0.807).Conclusions：Through the implementation of individual intervention study, village doctorsincreased knowledge of EHR in daily work, the operation was more skilled.The application amplitude, frequency and quality of EHR were dramaticallyimproved. The public health service record improved dramatically. The basicmedical records in EHR have been improved to a certain extent.This study demonstrated that as long as village doctors recognized EHR useful for their work and skilled, feel easy to use, they can take the initiative to useEHR. Coupled with appropriate incentives and the necessary rules and regulations,a long-term mechanism to promote village doctors using EHR could be established.In depressed rural areas, this model did not require a special fee or healthworkforce. It was feasible in depressed areas and worthy of dissemination to othersimilar areas.