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

项目摘要/摘要 对于临床医生来说，使用跨医疗系统交换的患者健康信息通常很麻烦，而且 颠覆性。系统评价报告健康信息交换(HIE)对医疗保健的积极影响 过程和结果，如减少重复/不必要的检查、费用和入院/再入院 费率。然而，在HIE被广泛和牢固地整合到临床医生的实践和工作流程之前，这是不可能的 我们将充分认识到在采用和使用卫生保健方面的重大投资的潜在好处 信息技术。HIE和电子健康记录(EHR)的直接集成尚未得到广泛应用 实施和研究，提供机会来衡量如何将相关和及时的信息 与传统的访问信息的方式相比，直接在临床医生的指尖上访问可能会影响医疗保健 是他的病。我们项目的目标是评估一个名为CareView的新型应用程序，该应用程序可以无缝地 将来自HIE的高度相关信息直接与急诊科(ED)的EHR整合。 我们的中心假设是，HIE/EHR的这种整合将增加HIE信息的使用并改善护理 与当前的访问方法相比，交付、患者结果以及临床医生的满意度和效率 他的数据。我们的具体目标是评估HIE/EHR整合在以下方面的影响：(1)临床医生的看法和 在急诊环境中接受HIE；(2)急诊医生使用HIE；以及(3)临床护理流程和 急诊室的结果。基于我们在印第安纳大学(IU)健康中心成功实施的2018年试点 卫理公会，我们将在额外的IU健康急诊室推出CareView 在总共14个IU健康急救室中进行为期两个月的三到四个地点的波。使用 阶梯式楔形、整群非随机对照研究设计，每个部位设一个对照， 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，我们预计我们的 这项研究涉及大约139名临床医生，他们每年在该院37万人次的急诊中就诊近100,000人次 卫生系统。我们的项目意义重大，因为它将评估一种高效和有效地检索 来自EHR内HIE的相关信息；重点关注ED，在那里使用HIE信息通常是 高度相关和有影响力；并为互操作性的实施和影响产生证据， 联邦、州和其他机构的关键卫生IT重点。这个项目是创新的，因为它(1)无缝 将HIE数据与EHR集成；(2)使用新的快速医疗互操作性资源(FHIR) AHRQ认可的标准，以便于推广；以及(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。这一项目将促进 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.