A Study of an EHR to Translate Public Health Practices

描述(由申请人提供)： 充分的证据表明，预防保健提醒、质量衡量、免疫接种登记和患者教育材料等公共卫生要素提供了公共卫生价值，但传播很差。电子健康记录(EHR)可能提供一种解决方案，但EHR的不良采用和公共卫生要素在EHR中的不良结合限制了它们的广泛使用。纽约市政府正在实施一项独特的项目，以改善该市的健康状况，投资2700多万美元，为全市治疗服务不足的患者的提供者实施公共卫生启用的EHR(PHEEHR)。我们的项目是研究纽约市PHEEHR的实施情况，目的是发现能够提高PHEEHR的采用率和影响力的策略。具体目标是：1)通过在实践环境中检查有助于采用和影响PHEEHR的背景因素来研究实施过程；2)研究公共卫生要素和环境任务要素之间的复杂关系如何促进或阻碍PHEEHR的采用和影响；以及3)根据目标1和2的结果开发和传播概括性结论。我们将使用DeLone和McLean信息系统模型来评估从PHEEHR系统本身开始的因果路径，并将用户满意度、采用率和影响纳入其中。这项研究的影响是多方面的，部分是通过根据2010年健康人和美国预防服务工作组指南提供预防性服务和公共卫生报告的提供商网站比例的增加来衡量的。DeLone和McLean模型和具有任务-技术匹配结构的扩展模型将使用从327个练习环境收集的定量、定性和关系数据进行实证检验。将使用多层结构方程建模(ML-SEM)来评估这两个模型。为了最大限度地提高研究结果的概括性，我们将坚持RE-AIM框架中的标准化多维报告指标，该框架专门为提高研究结果的可译性而设计。我们的目标是扩展我们从这项史无前例的纽约市PHHEHR实施研究中学到的东西，以告知其他可能在未来参与类似PHEEHR实施的人。

DESCRIPTION (provided by applicant): Ample evidence demonstrates that public health elements such as preventive care reminders, quality measurement, immunization registries, and patient education materials provide public health value, yet dissemination is poor. Electronic health records (EHRs) may provide a solution, but poor EHR adoption and poor incorporation of public health elements into EHRs limit their broad use. The New York City government is carrying out a unique project to improve the health of the city, investing over $27 million to implement a public health enabled EHR (PHEEHR) to providers who treat underserved patients throughout the city. Our project is to study this PHEEHR New York City implementation with the goal of discovering strategies that can enhance PHEEHR adoption and impact. Specific aims are 1) to study the implementation process by examining across practice settings the contextual factors that contribute to the adoption and impact of the PHEEHR; 2) to study how the complex relationships between public health elements and environmental task elements facilitate or hamper adoption and impact of the PHEEHR and 3) to develop and disseminate generalizable conclusions based on the results of aims 1 and 2. We will use the DeLone and McLean Information System Model to evaluate the causal paths that begin with the PHEEHR system itself, and incorporate user satisfaction, adoption, and impact. Impact in this study is multifaceted measured in part by an increase in the proportion of provider sites that perform preventative services and public health reporting based on Healthy People 2010 and the U.S. Preventive Services Task Force guidelines. The DeLone and McLean model and an extended model with a task-technology fit construct will be empirically tested with quantitative qualitative and relational data collected from 327 practice settings. Multilevel structural equation modeling (ML-SEM) will be used to evaluate both models. To maximize the generalizability of our findings, we will adhere to standardized multidimensional reporting metrics from the RE-AIM framework specifically designed to improve the translatability of research findings. Our goal is to extend what we learn from this unprecedented New York City PHHEHR implementation research study to inform others that are likely to engage in similar PHEEHR implementations in the future.