Coeus: An information tool to support safe admission to the nursing home

摘要 每年有2800多万名患者从医院出院到养老院(NH)。过渡时期 从医院到医院充满了困难，扰乱了居民的护理和福祉。对…的回顾 最近医院到NH的转移发现，近40%的居民在45天内经历了不良事件 出院的证据。NH工作人员依靠在这些急性护理环境中收集的信息来安全地接受和启动护理 对病人来说。然而，不幸的是，过渡进程受到信息交流不畅的困扰。放电 文书工作通常缺乏关键信息，如成像研究结果或抗生素停用日期，包括过期 信息，而不是被组织来支持国家卫生部门的决策。迫切需要制定一种 在入院时向NH提供商提供关键信息的解决方案。Probari，一家总部位于印第安纳州的小型 致力于通过支持性临床解决方案提高NH护理质量的企业及其合作伙伴 印第安纳大学的Regenstrief研究所正在开发Coeus，一种面向NH的转学申请，以填补这一空白 市场上有很大的差距。使用国家快速健康互操作性资源(FHIR)标准 健康数据的查询和共享以及可替代的医疗应用和可重用技术 (SMART)平台，Coeus将被集成到NHS的电子健康记录(EHR)中，以适应提供商 工作流并支持商业分发，并将快速收集和显示来自 最近的急性护理入院。一旦开发完成，Coeus将提高NH效率，增加员工和供应商 满意度，并提高居民安全，包括影响质量指标，如减少医院 重新入院。这一第一阶段项目将论证以下目标的可行性：目标1.建立 NH环境中以用户为中心的基于FHIR的传输应用的信息和设计要求。氨 工作人员将参加讨论和多学科设计研讨会，以确定如何最好地组织 支持决策和功能需求的信息。目标2.实施最终用户设计 需求并构建Coeus原型。目的3.建立Coeus原型的可用性。普罗巴里将 在模拟的EHR沙箱环境中部署Coeus原型，并评估其在最终用户中的可用性。 在第一阶段结束时，普罗巴里将在以下方面证明Coeus的总体可行性和可用性 潜在的NH终端用户。第二阶段将专注于将最低限度可行的产品部署到临床工作流程中 评估为商业化做准备的潜在影响。Coeus满足了临床护理需求，并拥有 通过支持基于NH的医疗保健提供商访问信息获得市场机会，从而实现更高的 优质护理。一旦完全商业化，Coeus的主要市场将是美国的15,600个NHS。

Abstract More than 28 million patients are discharged from the hospital to a nursing home (NH) each year. The transition from hospital to NH is fraught with difficulties and is disruptive to residents’ care and well-being. A review of recent hospital to NH transfers found that nearly 40% of residents experienced an adverse event within 45 days of discharge. NH staff rely on information collected in these acute care settings to safely admit and initiate care for patients. However, unfortunately the transition process is plagued by poor information exchange. Discharge paperwork often lacks key information such as imaging study results or antibiotic stop dates, includes out of date information and is not organized to support decision making in the NH. There is a critical need to develop a solution that provides key information to NH providers at the time of admission. Probari, an Indiana-based small business dedicated to improving the quality of NH care through supportive clinical solutions, and its partners at Indiana University’s Regenstrief Institute, are developing Coeus, a NH-facing transfer application to fill this significant gap in the market. Using the national Fast Health Interoperability Resources (FHIR) standards for querying and sharing health data and the Substitutable Medical Applications and Reusable Technologies (SMART) platform, Coeus will be integrated into NHs’ electronic health records (EHRs) to fit within provider workflows and to support commercial distribution and will quickly gather and display relevant information from recent acute care admissions. Once developed, Coeus will increase NH efficiency, increase staff and provider satisfaction, and improve resident safety including impacting quality metrics such as reduced hospital readmissions. This Phase I project will demonstrate feasibility with the following Aims: Aim 1. Establish the information and design requirements for a user-centered FHIR-based transfer application in a NH setting. NH staff will participate in discussions and a multi-disciplinary design workshop to determine how best to organize information to support decision making and functional requirements. Aim 2. Implement end-user design requirements and build the Coeus prototype. Aim 3. Establish the usability of the Coeus prototype. Probari will deploy the Coeus prototype in a simulated EHR sandbox environment and assess its usability among end users. At the end of Phase I, Probari will have demonstrated the overall feasibility and usability of Coeus among potential NH end users. Phase II will focus on deployment of a minimally viable product into a clinical workflow to evaluate potential impact in preparation for commercialization. Coeus meets a clinical care need and has market opportunity by supporting NH-based healthcare providers’ access to the information that enables higher quality care. Once fully commercialized, Coeus’ primary market will be the 15,600 NHs in the US.