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

背景/理由：数百万退伍军人同时接受退伍军人和非退伍军人医疗保健 供应商。健康信息交换(HIE)技术相对较新，并且 在退伍军人事务部实施。HIE允许退伍军人管理局的提供者发送和接收来自 非退伍军人医疗机构。这种数据交换对于协调患者的 药物，协调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。通过最近的退伍军人访问、选择和责任法案 2014年，更重要的是培养有效的HIE，以改善提供商的决策。 然而，报告表明，退伍军人管理局的HIE技术不足以支持药物治疗 对账任务，并未被提供者充分利用。此外，HIE用药数据和VA 用药指令显示在单独的显示屏上，限制了HIE数据的使用，并阻碍了 供应商协调用药的能力。 目标：研究目标是确定提供者潜在的认知需求，以便 制定一套呈现VA和HIE用药数据的技术设计指南。我们 假设，与当前的退伍军人管理局技术相比，这项研究的设计指南 可以显著提高提供商决策的质量和安全，包括 药物对账的效率和准确性。具体目标如下： 目标1：评估退伍军人事务部HIE接口用于支持提供商的优势和劣势 护理背景下的用药协调的工作流程和决策过程。 AIM 1将产生一套初步的HIE设计指南，以支持提供者的工作流程。 目标2：确定提供者在药物调节任务中使用的认知策略。 AIM 2将产生一套初步的HIE设计指南，以支持提供者的认知。指导方针 AIMS 1、2将被翻译成VA-HIE接口的新原型。 目的3：评价新型VA-HIE界面是否符合设计指南 显著提高供应商的质量和安全表现。 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界面对提供商工作流程的支持程度。定性数据 将在地理上分散的四个退伍军人医疗中心收集。在《目标2》中，卡片分类 并将对住院和门诊提供者进行模拟访谈，以确定 药物调节任务中涉及的潜在认知过程。对于目标3，我们将 在模拟环境中与提供者进行随机对照试验并收集 以定性和定量的数据来评价设计指南是否显著 提高服务提供者的用药对账效率和准确性。 意义：本研究将提供有关提供商认知的基础知识，即 确保退伍军人和退伍军人最大限度地受益于退伍军人事务部对HIE的投资 技术。研究结果可以用来增加供应商对HIE技术的采用 提高退役军人用药协调的质量和安全性。

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.