Empowering providers to improve care for disadvantaged patients: design and prototype testing of novel user interface for electronic health records

帮助医疗服务提供者改善对弱势患者的护理：电子健康记录新颖用户界面的设计和原型测试

• 批准号: 10401209
• 负责人: CHRISTOPHER KREIS
• 金额: $ 25.51万
• 依托单位: ASP.MD
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10401209
• 关键词: Acute; Address; Adoption; Artificial Intelligence; Caring; Chronic; Clinical; Clinical Data; Complex; Consumption; Data; Data Display; Diabetes Mellitus; Diagnosis; Diet; Dietary History; Disadvantaged; Electronic Health Record; Ensure; Environment; Exercise; Face; Future; Goals; Grant; Health; Health Personnel; Healthcare; Homelessness; Hypertension; Hypoglycemia; Insulin; Knowledge; Laboratories; Licensing; Machine Learning; Measures; Medicaid; Medical; Methods; Online Systems; Ophthalmology; Outcome; Patients; Pharmaceutical Preparations; Phase; Physicians; Population; Practice Management; Primary Health Care; Process; Production; Provider; Quality of Care; Reading; Resources; Risk; Role; Source; Specialist; Structure; Surveys; Symptoms; System; Technology; Testing; Time; TimeLine; Training; Underserved Population; United States; Vendor; Visit; Visual; Vulnerable Populations; Weight; Work; application programming interface; base; burnout; care providers; clinical decision support; clinically relevant; cloud based; cognitive load; commercialization; comorbidity; data quality; design; digital; disadvantaged population; disparity reduction; empowered; experience; foot; glucose monitor; health information technology; health practice; improved; innovation; interoperability; knee pain; longitudinal dataset; next generation; novel; point of care; preference; pressure; prototype; satisfaction; social; social health determinants; tool; trend; usability; user centered design

PROJECT SUMMARY There is an emerging digital divide in healthcare between those who care for disadvantaged patients and those who care for less vulnerable populations. In the past decade, electronic health record (EHR) adoption and use has increased but unequally. Providers caring for disadvantaged populations are less likely to have and use advanced EHRs with sophisticated clinical decision support, analytics, and other functionalities. While EHRs are failing to meet the needs of United States’ providers more generally, EHR-related challenges are particularly acute for providers who treat disadvantaged populations due to time pressures, limited resources, and the need to address many social issues. Furthermore, EHRs have resulted in the accumulation of vast amounts of data, but providers do not have time to sift through it all in a patient encounter – better tools are needed to summarize, organize, and display the data in a way that better supports care. For chronic conditions such as diabetes, providers need to instantly see, assess, and take action on their patients’ status in a glance, without searching through laboratory results, weights, diet, history, medications, notes, and comorbidities scattered throughout a system. ASP.MD and the RAND Corporation have developed preliminary designs for a more usable EHR user interface (UI) that organizes and consolidates clinical data into “Viewers” based on clinically meaningful problems. Viewers are far more advanced than traditional problem lists. They visualize context- relevant longitudinal data, set visit agendas, track tasks, and execute other clinically useful activities. These visual innovations help providers quickly assess a patient’s overall status and specific clinical needs based on their data and symptoms. In this work, we will engage providers who care for Medicaid and other disadvantaged populations to further develop and test this novel EHR UI. In Aim 1, we will use user-centered design methods to develop detailed prototypes and clinical scenarios for testing. The scenarios will be common for providers who treat disadvantaged populations and they will promote improvement on established quality measures. We will integrate these prototypes into an existing EHR, developed by ASP.MD. In Aim 2, we will test the usability of the prototypes through structured sessions. ASP.MD is an ideal setting for developing and testing this innovation by building off its existing, federally certified commercial EHR and practice management systems. ASP.MD’s EHR is web-based, making it possible to immediately distribute new features to all users. We will build using the standards-based fast health interoperability resource (FHIR) application programming interfaces (API), making it possible to use our Viewers with other EHRs as well. This work has the potential to substantially reduce disparities by giving providers who care for disadvantaged populations an affordable, advanced EHR. Providers will have access to relevant, organized, synthesized clinical data at the point of care, facilitating their ability to close quality of care gaps and reducing burnout. It also has the potential to greatly improve the quality of data in EHRs, which can enable further innovation.

项目摘要 在医疗保健领域，照顾弱势患者的人和照顾弱势患者的人之间正在出现数字鸿沟。 为不那么脆弱的人群。在过去的十年中，电子健康记录（EHR）的采用和使用有所增加，但 不平等。照顾弱势群体的提供者不太可能拥有和使用先进的EHR， 复杂的临床决策支持、分析和其他功能。虽然EHR未能满足 更普遍地说，与EHR相关的挑战对于治疗的提供者来说尤其严重。 由于时间压力、资源有限以及需要解决许多社会问题，这些国家正在努力解决弱势群体的问题。 此外，电子健康记录积累了大量数据，但提供者没有时间进行筛选 通过这一切，在病人的遭遇-更好的工具，需要总结，组织和显示数据的方式， 更好地支持护理。对于糖尿病等慢性疾病，提供者需要立即查看，评估并采取行动 他们的病人的状态一目了然，而无需搜索实验室结果，体重，饮食，病史，药物，笔记， 和分散在整个系统中的合并症。ASP.MD和兰德公司已经开发了初步的 设计了一个更可用的EHR用户界面（UI），该界面基于以下内容将临床数据组织并整合到“查看器”中： 有临床意义的问题。查看器比传统的问题列表先进得多。他们把背景形象化- 相关的纵向数据，设置访问议程，跟踪任务，并执行其他临床有用的活动。这些视觉 创新帮助医疗服务提供者根据他们的数据快速评估患者的整体状况和特定的临床需求， 症状在这项工作中，我们将让医疗补助和其他弱势群体的提供者参与进来， 开发和测试这个新的EHR UI。在目标1中，我们将使用以用户为中心的设计方法来开发详细的原型 和临床场景进行测试。这些情景对于治疗弱势群体的提供者来说是常见的， 促进改善既定的质素措施。我们将把这些原型整合到现有的 EHR，由ASP.MD开发。在目标2中，我们将通过结构化会话测试原型的可用性。ASP.MD是 一个理想的环境，开发和测试这一创新的基础上建立其现有的，联邦认证的商业电子病历 实践管理制度。ASP.MD的EHR是基于Web的，可以立即分发新的 功能给所有用户。我们将使用基于标准的快速健康互操作性资源（FHIR）应用程序 编程接口（API），使我们的查看器也可以与其他EHR一起使用。这项工作有可能 通过为照顾弱势群体的提供者提供负担得起的先进的 电子病历提供者将在护理点获得相关的、有组织的、综合的临床数据， 能够缩小护理质量差距并减少倦怠。它还具有极大提高数据质量的潜力 在EHR中，这可以实现进一步的创新。