电子健康技术与公立医院医疗工作活动的整合：批判现实主义的观点
EHealth Technologies Integration with Healthcare Work Activities in Public Hospitals: A Critical Realist Perspective
摘要：
电子健康技术与医疗工作活动的整合在发展中国家的许多医疗系统中取得了巨大进步。然而，这些努力受到了一些挑战的影响，如分散、缺乏标准化和协调。因此，卫生战略/政策文件中阐述的电子保健承诺尚未充分实现。这意味着大多数人口仍然无法获得充分的医疗保健服务。本文的目的是解释为什么目前的整合工作没有充分促进医疗工作活动在公立医院在南非的服务不足的情况下。采用了定性方法中的批判现实主义观点。共有21名参与者进行了有目的的抽样和采访，因为他们的知识和经验，在医疗服务提供过程中，以及他们参与整合电子健康。本研究以活动分析与发展（ActAD）模型为理论分析工具，并以规范化过程理论（NPT）为解释框架。研究结果突出了生成机制，如系统的适合在医疗工作流程的目的分析不足，在电子健康的整合过程中有抑制作用。
英文摘要：
Integration of eHealth technologies with healthcare work activities has seen great advancement in many healthcare systems in developing countries. However, these efforts have been tainted by several challenges such as fragmentation, lack of standardization and co-ordination. Subsequently, the undertakings of eHealth articulated in health strategy/policy documents have not been fully realised. The implications of this has been that the majority of the population still access inadequate healthcare services. The aim of this paper is to explain why the current integration efforts do not adequately facilitate healthcare work activities in public hospitals in under-served contexts of South Africa. A critical realist perspective within a qualitative approach was adopted. A total of 21 participants were purposively sampled and interviewed because of their knowledge and experience in the healthcare service delivery process as well as their involvement in the integration of ehealth. The study applied the Activity Analysis and Development (ActAD) model as a theoretical analytical tool and draws on normalization process theory (NPT) as an explanatory framework. The findings highlight generative mechanisms such as the inadequate analysis of system's fit-for-purpose in healthcare workflows have inhibiting effects in the integration process of eHealth.
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