Improving healthcare processes and outcomes by directly integrating health information exchange data in the clinical workflow

项目总结/摘要 对于临床医生来说，使用跨医疗保健系统交换的患者健康信息通常是麻烦的， 破坏性的系统评价报告了健康信息交换（HIE）对医疗保健的良好影响 过程和结果，如减少重复/不必要的测试，成本和入院/再入院 rates.然而，在HIE广泛而牢固地融入临床医生的实践和工作流程之前， 我们将充分认识到在采用和使用卫生技术方面进行重大投资的潜在好处， 信息技术。HIE和电子健康记录（EHR）的直接整合尚未得到广泛应用。 实施和研究，提供机会衡量如何将相关和及时的信息 直接在临床医生的指尖可以影响护理相比，传统的方式访问信息， 缺氧缺血性脑病我们项目的目标是评估一个名为CareView的新应用程序， 将来自HIE的高度相关信息直接与急诊科（艾德）中的EHR集成。 我们的中心假设是，这种HIE/EHR整合将增加HIE信息的使用，并改善护理 与目前的访问方法相比，交付、患者结局以及临床医生满意度和效率 HIE数据。我们的具体目标是评估HIE/EHR整合对以下方面的影响：（1）临床医生的看法， 艾德环境中对HIE的接受程度;（2）艾德临床医生对HIE的使用;（3）临床护理过程和 根据我们在印第安纳州大学（IU）健康中心成功实施的2018年试点项目， 卫理公会，最大的艾德在IU卫生系统，我们将推出CareView在其他IU健康ED在 三到四个站点的干预期为两个月，共14个IU健康ED。使用 阶梯楔形、群集非随机对照研究设计，每个研究中心将作为对照， 随后，干预现场。CareView支持胸痛，腹痛， 虚弱/头晕/头痛，背部/腰部疼痛，怀孕，心律失常和呼吸困难，我们希望我们的 在IU每年370，000次艾德访视中，约139名临床医生参与了近100，000次访视 卫生系统。我们的项目是重要的，因为它将评估一种方法，以有效地和有效地检索 来自EHR中HIE的相关信息;关注艾德，其中使用HIE信息通常 高度相关和有影响力;并为互操作性的实施和影响提供证据， 联邦、州和其他机构主要卫生信息技术重点。该项目是创新的，因为它（1）无缝 将HIE数据与EHR集成;（2）使用新的快速医疗保健互操作性资源（FHIR） 标准，该AHRQ已批准，以促进普遍性;（3）采用严格的研究设计 这使我们能够对HIE/EHR整合的影响做出因果推断。该项目将促进 医疗保健研究和质量机构（AHRQ）的使命，提供真实世界的证据 关于HIE对改善医疗保健流程、质量和患者结局的因果影响。

Project Summary/Abstract For clinicians, using patient health information exchanged across healthcare systems is often cumbersome and disruptive. Systematic reviews report promising effects of health information exchange (HIE) on healthcare processes and outcomes, such as decreased repeat/unnecessary tests, costs, and admission/readmission rates. However, until HIE is widely and firmly integrated in the practice and workflow of clinicians, it is unlikely that we will fully realize the potential benefits of the significant investment in the adoption and use of health information technologies. Direct integration of HIE and electronic health records (EHR) has not been widely implemented and studied, offering the opportunity to measure how putting relevant and timely information directly at the clinician’s fingertips could impact care compared to traditional ways of accessing information in an HIE. The objective of our project is to evaluate a novel application called CareView that seamlessly integrates highly relevant information from the HIE directly with the EHR in the emergency department (ED). Our central hypothesis is that this HIE/EHR integration will increase HIE information use and improve care delivery, patient outcomes, and clinician satisfaction and efficiency compared to current methods of accessing HIE data. Our specific aims are to assess the impact of HIE/EHR integration on: (1) clinician perceptions and acceptance of HIE in the ED setting; (2) HIE use by ED clinicians; and (3) clinical care processes and outcomes in the ED. Based on our successful 2018 pilot implementation at Indiana University (IU) Health Methodist, the largest ED in the IU Health system, we will roll out CareView at additional IU Health EDs in waves of three to four sites for intervention periods of two months in a total of 14 IU Health EDs. Using a stepped-wedge, cluster non-randomized controlled study design, each site will serve as a control and, subsequently, intervention site. CareView supports the clinical conditions of chest pain, abdominal pain, weakness/ dizziness/ headache, back/ flank pain, pregnancy, arrhythmia and dyspnea, and we expect our study to involve approximately 139 clinicians during nearly 100,000 of the 370,000 annual ED visits in the IU Health system. Our project is significant because it will evaluate a method to efficiently and effectively retrieve relevant information from an HIE within an EHR; focus on the ED, where using HIE information is typically highly relevant and impactful; and generate evidence for the implementation and impact of interoperability, a key health IT focus of federal, state and other agencies. The project is innovative because it (1) seamlessly integrates HIE data with the EHR; (2) uses the novel Fast Healthcare Interoperability Resources (FHIR) standard, which the AHRQ has endorsed, to facilitate generalizability; and (3) employs a rigorous study design that allows us to make causal inferences about the impact of HIE/EHR integration. This project will promote the mission of the Agency for Healthcare Research and Quality (AHRQ) by providing real-world evidence regarding the causal effects of HIE on improving healthcare processes, quality and patient outcomes.