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

通过直接将健康信息交换数据集成到临床工作流程中来改善医疗保健流程和结果

• 批准号: 10480844
• 负责人: TITUS K. SCHLEYER
• 金额: $ 39.19万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10480844
• 关键词: Improving; healthcare; processes; outcomes; directly

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.

项目概要/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很麻烦并且 破坏性的。系统评价报告健康信息交换 (HIE) 对医疗保健的良好影响 流程和结果，例如减少重复/不必要的测试、成本和入院/再入院 费率。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，它不太可能 我们将充分认识到在采用和使用卫生保健方面进行大量投资的潜在好处 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，提供了衡量如何提供相关和及时信息的机会 与传统的获取信息的方式相比，直接在临床医生的指尖可能会影响护理 一个 HIE。我们项目的目标是评估一个名为 CareView 的新颖应用程序，该应用程序可以无缝地 将 HIE 的高度相关信息直接与急诊科 (ED) 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 与当前的访问方法相比，交付、患者结果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) 临床医生的看法和 在急诊室接受 HIE； (2) 急诊科临床医生使用 HIE； (3) 临床护理流程和 急诊科的结果。基于我们 2018 年在印第安纳大学 (IU) Health 成功试点实施 卫理公会是 IU Health 系统中最大的急诊室，我们将在其他 IU Health 急诊室推出 CareView 在总共 14 个 IU Health ED 中分三到四个地点进行为期两个月的干预。使用 阶梯楔形、集群非随机对照研究设计，每个站点将作为对照， 随后，干预现场。 CareView 支持胸痛、腹痛、 虚弱/头晕/头痛、背部/胁腹疼痛、怀孕、心律失常和呼吸困难，我们期望我们的 该研究涉及约 139 名临床医生，每年 370,000 次 IU 急诊就诊中的近 100,000 次就诊 卫生系统。我们的项目很重要，因为它将评估一种高效且有效地检索的方法 EHR 内 HIE 的相关信息；重点关注 ED，通常使用 HIE 信息 高度相关且有影响力；并生成互操作性的实施和影响的证据， 联邦、州和其他机构的主要健康 IT 焦点。该项目具有创新性，因为它 (1) 无缝地 将 HIE 数据与 EHR 集成； (2) 使用新颖的快速医疗互操作性资源 (FHIR) AHRQ 已认可的标准，以促进通用性； (3) 采用严格的研究设计 这使我们能够对 HIE/EHR 集成的影响做出因果推断。该项目将促进 通过提供真实世界的证据来履行医疗保健研究和质量局 (AHRQ) 的使命 关于 HIE 对改善医疗流程、质量和患者结果的因果影响。