Development and evaluation of patient medical summary from health information exchange to improve dental care

项目摘要 为了避免潜在的伤害和提高牙科治疗的成功率，牙科临床医生（DC）必须获得高达 记录患者的病史和用药史。最近的研究报告了与患者的差异- 电子牙科记录（EDRs）中报告的病史，以及医生对 DCs的医疗咨询导致延迟牙科护理。大型医疗保健组织（HCO），如牙科 学校和健康管理组织实施了综合医疗-牙科电子健康记录 (EHR)（整合电子健康记录及电子病历），以改善医疗及牙科之间的沟通及转介 专业人士然而，仅仅部署这种系统并不能解决目前的障碍，因为 相关的患者特异性信息可能分散在不同的HCO中，存储在各种EHR中 路段此外，大多数牙科专业人员没有资格与HCO有机会获得综合 电子病历系统。社区和供应商支持的卫生信息交换（HIE）的出现 而交换和显示相关信息的技术和标准的发展， 发展中国家有机会建立一个综合护理提供模式，无论其实践环境如何。 长期目标是改善牙科临床医生和医疗机构之间的沟通和转诊。 改善病人护理及推广慢性病的检查和预防管理。 该提案旨在开发和评估从国家进口的可用的患者医疗摘要（PMS）- 广泛的社区印第安纳州健康信息交换（IHIE），更新牙科临床医生关于他们的 患者的病史，甚至可以在单独和小团体牙科实践设置中使用。中央 假设PMS将具有更高百分比的完整和最新的医疗信息， 这将减少评估牙科病人个案所需的平均时间，并由区议会决定， 临床上有用。这三个具体目标是：1）确保信息项目的相关性和及时性， 有助于PMS评估患者的医疗状况; 2）开发原型，将PMS与 通过以用户为中心的设计方法进行EDR; 3）评估PMS的有效性和效率， 普通和专科牙医。两个主要成果是快速医疗保健互操作性资源 （FHIR）的PMS应用程序和重新配置的整合临床文档架构（C-CDA）， 减少牙科医生对患者和医生办公室信息的依赖，减轻患者负担 与DC共享信息。这项研究将为跨专业的牙科- 医疗保健服务，提高牙科和整体护理在美国人口，促进预防 管理，并降低牙科护理成本。

Project Summary To avoid potential harm and improve dental treatment success, dental clinicians (DCs) must obtain an up-to- date medical and medication history of their patients. Recent studies have reported discrepancies with patient- reported medical histories in electronic dental records (EDRs), and inconsistencies in physicians’ responses to DCs’ medical consults leading to delayed dental care. Large healthcare organizations (HCO) such as dental schools and health management organizations implemented integrated medical-dental electronic health record (EHR) (integrated EHR-EDR) to improve communication and referral between medical and dental professionals. However, deploying such systems alone will not resolve the current barriers because the relevant patient-specific information may be fragmented across different HCOs, stored in various EHR sections. Besides, most dental professionals are not credentialed with HCOs to have access to an integrated EHR-EDR system. The emergence of community and vendor-supported health information exchanges (HIEs) and the development of technologies and standards to exchange and display pertinent information is an opportunity for DCs to establish an integrated care delivery model regardless of their practice setting. The long-term goal is to improve communication and referrals between dental clinicians and medical professionals to improve patient care and promote screening and preventive management of chronic diseases. This proposal aims to develop and evaluate a usable patient medical summary (PMS) imported from the state- wide community Indiana Health Information Exchange (IHIE) that updates a dental clinician about their patients’ medical history and can be used even in solo- and small group dental practice settings. The central hypothesis is that the PMS will have a higher percentage of complete and up-to-date medical information, which will reduce the average time required to assess a dental patient case and determined by DCs to be clinically useful. The three specific aims are: 1) Validate the relevance and timeliness of information items that contribute to the PMS to assess a patients’ medical status; 2) develop prototypes that integrate the PMS with an EDR through user-centered design methods; 3) evaluate the effectiveness and efficiency of the PMS with general and specialist dentists. The two primary outcomes are a Fast Healthcare Interoperability Resources (FHIR)-based PMS application and a reconfigured Consolidated Clinical Document Architecture (C-CDA) that reduce dental clinicians’ reliance on patients and physicians’ office for information and reduce patients’ burden to share information with DCs. The proposed study will lay the foundation for an interprofessional dental- medical care delivery that enhances dental and overall care among the US population, promotes preventive management, and reduces dental care costs.