Value of Health Information Exchange in Ambulatory Care

描述(由申请人提供)：需要临床数据才能从大多数健康信息技术中获得价值。由于国家的医疗保健系统是支离破碎的，这些临床数据是支离破碎的，在护理时不可用。健康信息交换是一个术语，用于描述在不同组织中聚合患者临床数据的努力，以便形成更完整的医疗保健图景，以改善临床护理和质量、研究和公共卫生。该项目将完善已建立的卫生信息交换(HIE)经济模型，创建一个可以测试该模型的“实验室”，最后在随机对照试验中测试该模型的预测。现有的HIE(印第安纳州患者护理网络)将作为该项目的基础。此外，已有几个付款人参与了这一项目，以便提供部分数据，同时也为根据调查结果改变偿还模式奠定基础。由信息技术领导中心(CITL)从国家角度开发的HIE经济模型将进行修改，以支持其在区域基础上的使用，然后使用该项目随机试验的数据验证该模型。为了在非卧床环境下进行HIE的随机试验，申请人需要创建一个医生实践和数据源的“实验室”，以便能够在非卧床环境中测量HIE的影响。研究人员将仿照急诊科的模型来模拟这个“实验室”，该模型现已用于两个大型试验。最后，研究人员将在门诊环境中通过向整个社区的提供者提供临床数据来进行HIE的随机对照试验。该国面临着医疗成本、质量和安全方面的危机，越来越多的证据表明，医疗信息技术可能是解决方案的一部分。为了让这些技术中的许多实现其承诺，它们需要临床数据，这些数据驻留在零散和未连接的数据库中，但可以通过卫生信息交换将其结合在一起。

DESCRIPTION (provided by the applicant): Clinical data is required in order to derive value from most health information technology. Because the Nation's healthcare system is fragmented, these clinical data are fragmented and not available at the point of care. Health information exchange is the term used to describe efforts to aggregate clinical data for patients across disparate organizations in order to form a more complete picture of their care that improves clinical care and quality, research and public health. This project will refine an established economic model of health information exchange (HIE), create a "laboratory" in which that model can be tested and, finally, test the model's predictions in a randomized controlled trial. An existing HIE (the Indiana Network for Patient Care) will be used as the foundation for this project. In addition, several payers have been engaged in this project in order to provide part of the data, but also to lay the foundation for changes in reimbursement models based on the findings. The economic model of HIE, developed by the Center for Information Technology Leadership (CITL) from a national perspective, will be modified to support its use on a regional basis and then to validate the model using data from this project's randomized trial. In order to perform the randomized trial of HIE in the ambulatory setting, the applicant needs to create a "laboratory" of physician practices and data sources that will enable the measurement of the effects of HIE in the ambulatory setting. The investigator will model this "laboratory" after the emergency department model which has now been used for two large trials. Finally, investigators will carry out a randomized controlled trial of HIE in the ambulatory setting by delivering clinical data to providers from across the entire community. The country is faced with a crisis in health care costs, quality and safety and there is increasing evidence that health information technology may be part of the solution. In order for many of these technologies to deliver on their promise, they need clinical data, data that resides in fragmented and unconnected databases but that can be brought together by health information exchange.