Evaluating Smart Forms and Quality Dashboards in an EHR

描述（由申请人提供）：电子健康记录（EHR）已成年。现代临床实践要求临床医生注意最佳实践，并警惕过度使用和成本。然而，大量数据表明，最佳证据和实践之间存在差距，临床实践模式存在很大差异，医疗成本的上升在很大程度上有增无减。IT在医疗保健中的基本价值主张受到越来越多的审查，同时越来越多的人认识到，IT的有效应用对于提高患者安全和质量至关重要。该应用程序旨在通过创建与临床文档工作流集成的临床决策支持工具，并通过提供医生对电子病历质量和基准的绩效反馈，更好地向最终用户临床医生展示IT的价值。我们的目标是向临床医生展示价值，以及患者安全和质量的目标，并通过创新的电子病历技术解决临床工作流程支持和决策支持的综合需求。我们假设两种基于电子病历的干预措施：第一种侧重于基于表格的、以临床文件为中心的决策支持方法的影响，第二种侧重于为临床医生提供关于指南依从性和护理点质量基准成就的具体绩效报告，这将显著提高电子病历对最终用户临床医生的感知价值。我们建议解决三个相关的研究问题来阐明这一探究领域：1)能否开发一种可用的电子病历干预措施，在临床文档工作流程的背景下提供临床决策支持，并将基于人群的绩效反馈集成到医生身上；2)这些工具是否改善了临床决策支持和质量评估的关键数据的获取，是否符合最佳实践指南，以及临床文件的质量；3)这些工具的使用是否具有成本效益——在为急性呼吸道疾病（ARI）或冠状动脉疾病（CAD）患者提供护理的环境中，药物、测试和程序的使用是否有影响？我们相信这些是基本的价值问题，对于在实践中广泛采用IT至关重要。如果最终用户没有意识到这些工具主要在临床工作流程中的价值，那么医疗保健IT将永远不会被采用，并且将永远无法实现患者安全、质量和成本方面的次要收益。

DESCRIPTION (provided by the applicant): Electronic health records (EHR) have come of age. Modern clinical practice requires a clinician to be mindful of best practices, and wary of excess utilization and cost. However, abundant data show that gaps exist between best evidence and practice, wide variations persist in clinical practice patterns, and escalation of healthcare costs continues largely unabated. The fundamental value proposition of IT in health care has come under increased scrutiny while it is increasingly accepted that the effective application of IT is critical for improved patient safety and quality. This application aims to better demonstrate the value of IT to the end-user clinician through creation of clinical decision support tools integrated with clinical documentation workflow, and through provision of physician performance feedback on quality and benchmarks in the EHR. We aim to demonstrate value to the clinician, as well as to the goals of patient safety and quality, and address the combined needs of clinical workflow support and decision support with innovative EHR technology. We hypothesize that two EHR-based interventions: the first focusing on the impact of a forms-based, clinical documentation-centric, approach to decision support, and the second on providing clinician specific performance reports regarding guideline compliance and quality benchmark achievement at the point of care, will significantly increase the perceived value of EHR to the end-user clinician. We propose to address three related research questions to illuminate this area of inquiry: 1) can a usable EHR intervention be developed which provides clinical decision support in the context of clinical documentation workflow, and which integrates population-based performance feedback to the physician; 2) do such tools improve the capture of key data for clinical decision support and quality assessment, compliance with best practice guidelines, and the quality of clinical documentation, and 3) is the use of such tools cost-effective - is there an impact utilization of medications, tests, and procedures in the setting of either care provided for patients with acute respiratory illness (ARI), or coronary artery disease (CAD)? We believe these are fundamental value questions which are critical to the broad adoption of IT in practice. If the end-user does not perceive the value of these tools primarily in the clinical workflow, healthcare IT will never be adopted, and secondary gains in patient safety, quality, and costs will never be achieved.