Reducing Risks by Engineering Resilience into Health Information Technology for E

描述(申请人提供)：目标。这一应用程序有两个广泛的长期目标：1.减少先前进行的关于急诊科(ED)环境中与信息技术(IT)相关的故障的前瞻性风险评估(PRA)中确定的危险。2.通过增强信息技术系统及其所嵌入的更大的社会技术系统的能力，提高卫生信息技术的复原力，使其能够在预期或意外的挑战下生存并恢复正常运作，并将对患者的不利影响降至最低。具体目标：本项目的具体目标是：1.开发一个工具包，使各组织能够持续地确定其各种信息系统的安全关键程度并对其进行评级。2.开发工具包，协助各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.开发工具包，协助各组织在购置期间评估拟议系统的安全性。4.在参与开发的两个地点实施具体目标1-3中开发的工具。5.评估在具体目标1-4中开发和改进的工具的普适性，办法是在另一个仅有最少参与其开发的地点实施这些工具，并评价其有效性。方法：研究方法。这些目标将分三个阶段实现，大致对应于项目年份。第一阶段将侧重于开发仪器和工具包，使军事和其他高危险行业中使用的现有仪器适应卫生保健环境。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试验场实施和试行，以评估其可行性和资源需求，并可能进行进一步修改。第三阶段将涉及在与开发没有密切关系的测试点实施(暂定为弗吉尼亚州里士满的VCU卫生系统，但目前可能会发生变化)，并通过与控制点的比较来评估其对组织程序和决策的影响。 公共卫生相关性：信息技术(IT)被广泛视为提高卫生保健安全、质量和效率的必要因素，但成功使用IT并非易事，每一次成功都会有许多失败。这些失败不仅在人力和资金方面代价高昂，而且可能会将患者置于危险之中，并导致组织无法或不愿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，我们希望提高非卧床医疗保健环境中IT系统的安全性和弹性，从而加快医疗保健组织成功采用的速度。

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.