A Human Factors Investigation of Health Information Exchange: Tools to Support Providers’ Coordination of Medications

背景/理由：数百万退伍军人接受VA和非VA医疗保健的护理 提供商健康信息交换（HIE）技术相对较新， 在整个VA中执行。HIE允许VA提供者发送和接收来自 非医疗机构。这种数据交换对于协调患者的 药物，调和药物以反映患者实际服用的药物，并减少 药物不良事件的风险。随着最近的退伍军人准入，选择和责任法案， 2014年，培养有效的HIE以改善供应商决策变得更加关键。 然而，报告表明，VA的HIE技术不足以支持药物治疗 协调任务，提供者利用不足。此外，HIE用药数据和VA 药物订单显示在单独的显示器中，限制了HIE数据的实用性，并妨碍了 供应商协调药物的能力。 目的：研究目的是确定提供者的基本认知需求，以便 制定一套技术设计指南，用于提供VA和HIE药物数据。我们 假设，与当前的VA技术相比，本研究的设计指南 可以显著提高供应商决策的质量和安全性，包括 药物核对的效率和准确性。具体目标如下： 目标1：评估VA的HIE接口的优点和缺点，以支持提供商的 工作流程和决策过程中的药物协调的背景下，护理。 目标1将产生一套初步的HIE设计指南，以支持供应商的工作流程。 目的2：确定提供者用于药物协调任务的认知策略。 目标2将产生一套初步的HIE设计指南，以支持供应商的认知。准则 目标1、2中的目标将被翻译成VA-HIE接口的新型原型。 目的3：评价新型VA-HIE接口，以评估设计指南是否 显著提高供应商业绩的质量和安全性。 方法：对于目标1，将进行现场观察、访谈和远程可用性测试 与住院和门诊提供者（处方医生和药剂师）一起生成基线， 探索性评估HIE界面如何支持供应商工作流程。定性数据 将在四个地理上分散的VA医疗中心收集。在目标2中，卡片排序 将与住院和门诊提供者进行模拟访谈，以确定 参与药物协调任务的潜在认知过程。目标3： 在模拟环境中与供应商进行随机对照试验， 定性和定量的数据，以评估是否设计准则显着 提高供应商的效率和药物核对的准确性。 意义：本研究将为供应商的认知提供基础知识， 确保退伍军人管理局和退伍军人最大限度地受益于退伍军人管理局对HIE的投资， 技术.研究结果可用于增加供应商对HIE技术的采用 提高退役军人用药协调质量和安全性。

Background/Rationale: Millions of Veterans receive care from both VA and non-VA healthcare providers. Health information exchange (HIE) technologies are relatively new and are implemented across VA. HIE allows VA providers to send and receive medication data from non-VA medical institutions. This data exchange is important to coordinate patients' medications, reconcile medications to reflect what the patient is actually taking, and reduce the risk of adverse drug events. With the recent Veterans Access, Choice, and Accountability Act of 2014, it is even more critical to foster effective HIE that improves provider decision-making. Reports indicate, however, that VA's HIE technologies are inadequately supporting medication reconciliation tasks and are underutilized by providers. In addition, HIE medication data and VA medication orders are shown in separate displays, limiting the utility of HIE data and impeding providers' ability to coordinate medications. Objectives: The study objective is to identify providers' underlying cognitive needs in order to develop a set of technology design guidelines for presenting VA and HIE medication data. We hypothesize that, compared to current VA technologies, design guidelines from this research can significantly improve the quality and safety of providers' decision-making, including the efficiency and accuracy of medication reconciliation. Specific aims are as follows: Aim 1: Assess the strengths and weaknesses of VA's HIE interfaces for supporting providers' workflow and decision-making processes for medication reconciliation in the context of care. Aim 1 will yield an initial set of HIE design guidelines to support providers' workflow. Aim 2: Identify the cognitive strategies that providers use for medication reconciliation tasks. Aim 2 will yield an initial set of HIE design guidelines to support providers' cognition. Guidelines from Aims 1, 2 will be translated into a novel prototype for the VA-HIE interface. Aim 3: Evaluate the novel VA-HIE interface to assess whether the design guidelines significantly improve the quality and safety of providers' performance. Methods: For Aim 1, field observations, interviews, and remote usability tests will be conducted with inpatient and outpatient providers (prescribers and pharmacists) to generate a baseline, exploratory assessment of how well HIE interfaces support provider workflow. Qualitative data will be collected across four geographically dispersed VA Medical Centers. In Aim 2, card sorts and simulation interviews will be conducted with inpatient and outpatient providers to identify the underlying cognitive processes involved in medication reconciliation tasks. For Aim 3, we will conduct a randomized controlled trial with providers in a simulated environment and collect qualitative and quantitative data in order to evaluate whether the design guidelines significantly improves providers' efficiency and accuracy of medication reconciliation. Significance: This research will provide foundational knowledge on provider' cognition, which is necessary to ensure that VA and Veterans maximally benefit from VA's investment in HIE technologies. Study findings can be used to increase providers' adoption of HIE technologies and enhance the quality and safety of medication coordination for Veterans.