Reducing Risks by Engineering Resilience into Health Information Technology for E

描述（由申请人提供）：目标。此应用有两个广泛的长期目标： 1. 减轻先前针对急诊科 (ED) 环境中信息技术 (IT) 相关故障进行的主动风险评估 (PRA) 中发现的危险。 2. 通过增强 IT 系统及其所嵌入的更大的社会技术系统的能力，提高卫生 IT 的弹性，使其能够在面临预期或意外挑战的情况下生存并恢复正常运行，并将对患者的不利影响降至最低。具体目标：该项目的具体目标是： 1. 开发一个工具包，使组织能够持续识别和排名其各种信息系统的安全关键性。 2. 开发一个工具包，帮助组织评估和改进其安全关键信息系统的维护计划和程序。 3. 开发一个工具包，以协助组织在采购过程中评估拟议系统的安全性。 4. 在参与开发的两个站点中实施具体目标 1-3 中开发的工具。 5. 通过在仅参与其开发最少的另一站点实施这些工具来评估具体目标 1-4 中开发和完善的工具的普遍性，并评估其有效性。方法。这些目标将分三个阶段实现，大致对应于项目年份。第一阶段将重点开发仪器和工具包，将军事和其他高危险行业使用的现有仪器应用于医疗保健环境。在第二阶段，这些工具将在杰克逊维尔和罗切斯特的阿尔法测试站点实施和试点，以评估其可行性和资源需求，并可能进行进一步修改。第三阶段将涉及在不密切参与开发的测试站点（暂定计划为弗吉尼亚州里士满的 VCU 医疗系统，但目前可能会发生变化）实施，并通过与对照站点进行比较来评估其对组织流程和决策的影响。 公共健康相关性：信息技术 (IT) 被广泛视为提高医疗保健安全、质量和效率的必要要素，但成功使用 IT 并不简单，每一次成功都伴随着许多失败。这些失败不仅在劳动力和资本方面代价高昂，而且可能使患者面临风险，并导致组织无法或不愿意在未来进行有时必要的技术变革。通过开发这些工具并将其置于公共领域，我们希望增强流动医疗机构中 IT 系统的安全性和弹性，从而加快医疗机构成功采用 IT 系统的步伐。

DESCRIPTION (provided by applicant): Objectives. There are two broad, long-term objectives for this application: 1. To mitigate the hazards identified in the previously conducted proactive risk assessment (PRA) with respect to information technology (IT) related failures in the emergency department (ED) setting. 2. To improve the resilience of health IT by enhancing the ability of IT systems, and the larger sociotechnical systems in which they are embedded, to survive and return to normal operations despite challenges, expected or unexpected, with a minimum of adverse effects on patients. Specific aims: The specific aims of this project are: 1. To develop a toolkit to enable organizations to identify and rank the safety-criticality of their various information systems on a continuing basis. 2. To develop a toolkit to assist organizations in evaluating and improving their maintenance plans and procedures for safety-critical information systems. 3. To develop a toolkit to assist organizations in evaluating the safety of proposed system during acquisition. 4. To implement the tools developed in Specific Aims 1-3 in two sites participating in their development. 5. To assess the generalizability of the tools developed and refined in Specific Aims 1-4 by implementing them in one additional site having only minimal participation in their development, and evaluating their effectiveness. Methods. These aims will be approached in three phases, roughly corresponding to project years. The first phase will focus on the development of instruments and toolkits by adapting existing instruments used in the military and other high hazard industries to the health care setting. In the second phase, the tools will be implemented and piloted at alpha test sites in Jacksonville and Rochester, to assess their feasibility and resource requirements, and may undergo further modification. The third phase will involve implementation at a beta site not intimately involved in development (tentatively planned to be the VCU Health System in Richmond, VA, but subject to change at this time), and evaluation of their effect on organizational processes and decision making by comparison to a control site. PUBLIC HEALTH RELEVANCE: Information technology (IT) is widely viewed as a necessary element for improving the safety, quality, and efficiency of health care, but successful use of IT is not simple, and for every success there have been many failures. These failures are expensive not only in terms of labor and capital, but may put patients at risk, and cause organizations to be unable or unwilling to undertake sometimes necessary technological changes in the future. By developing these tools and placing them in the public domain, we hope to enhance the safety and resilience of IT systems in ambulatory health care settings, and thereby to increase the pace of successful adoption in health care organizations.