Understanding Provider Workflow Needs in Electronic Communication

描述（由申请人提供）：这个奖项的目的是让我获得必要的培训，指导和经验，成为一个独立的卫生服务研究人员在病人安全和信息。我的最终目标是发展学术领导者的职业生涯，利用多学科科学来提高与电子健康记录（EHR）相关的医疗保健质量。为了实现这一目标，我将寻求发展和提高作为一个病人安全和信息健康服务研究人员工作所必需的技能。我将利用这个奖项提供的保护时间来获得三个主要领域的培训和经验：评估工作流程的技术，定性研究方法和人为因素原则。在诊断和治疗延迟从供应商之间的沟通故障是一个常见的问题，在卫生保健和有助于不良的病人结果和医疗事故诉讼。最近的医疗保健研究和质量机构特别强调通知（NOT-HS-13-009）强调了确定防止此类延迟的策略的重要性。我将以我们团队的工作为基础，揭示尽管提供者越来越多地使用基于电子健康记录（EHR）的工具来管理沟通，但这些延迟仍然存在。据信，造成这种延误的因素有多种，但有三种是常见的，经过充分研究，是理想的干预目标。这些问题包括：向提供者发送大量信息造成信息过载;缺乏基于电子健康档案的通信工具，以促进对情况的了解;现有电子通信工具的易用性差，导致信息处理效率低下。在本研究中，我将使用多学科的方法来评估电子通信工具。具体来说，我将评估供应商管理电子信息的流程，并确定影响通信效率和故障的因素。然后，我将使用这些信息来开发和测试一个原型工具，该工具可以提高处理效率、情景感知和易用性。该项目的具体目标是：目标1：评估供应商异步电子通信管理流程，以确定提供商的效率和态势感知的促进因素和障碍。目标2：开发一个异步电子通信原型工具，优化提供商的效率，态势感知和易用性。目标3：在模拟环境中评估原型工具的效率、态势感知和易用性。两名在患者安全和信息学研究方面具有丰富经验的高素质导师将监督培训，其中包括指导研究，正式课程，指导阅读和研讨会。拟议的活动将为电子通信工具的设计奠定基础，以提高对情况的了解、效率和易用性。这将减少通信故障导致的诊断延迟，并减少提供者EHR消息处理负担，从而为直接患者护理留出更多时间。

DESCRIPTION (provided by applicant): The objective of this award is to allow me to obtain the training, mentoring, and experience necessary to become an independent health services researcher in patient safety and informatics. My ultimate goal is to develop a career as an academic leader, using multidisciplinary science to improve the quality of health care related to electronic health record (EHR)-based communication. To accomplish this, I will seek to develop and sharpen a skill set essential to working as a patient safety and informatics health services researcher. I will use the protected time provided by this award to gain training and experience in three principal areas: techniques to evaluate workflow processes, qualitative research methodologies, and human factors principles. Delays in diagnosis and treatment from breakdowns in communication between providers are a common problem in health care and contribute to adverse patient outcomes and malpractice litigation. The importance of identifying strategies to prevent such delays has been highlighted in a recent Agency for Healthcare Research & Quality Special Emphasis Notice (NOT-HS-13-009). I will build on a foundation of work by our team revealing that despite providers' increased use of electronic health record (EHR)-based tools to manage communication, these delays persist. Multiple factors are believed to contribute to such delays, but three are frequent, well-studied, and serve as ideal targets for intervention. These include information overload from large numbers of messages transmitted to providers, lack of EHR-based communication tools that promote situational awareness, and poor ease of use of existing electronic communication tools, which leads to inefficiencies in message processing. In the research proposed, I will use multidisciplinary approach to evaluate electronic communication tools. Specifically, I will evaluate the processes used by providers to manage electronic messages and identify factors that impact communication efficiency and breakdowns. I will then use this information to develop and test a prototype tool that improves processing efficiency, situational awareness, and ease of use. The specific aims of this project are: Aim 1: Evaluate provider asynchronous electronic communication management processes in order to identify facilitators and barriers of provider efficiency and situational awareness. Aim 2: Develop an asynchronous electronic communication prototype tool that optimizes provider efficiency, situational awareness, and ease of use. Aim 3: Evaluate the efficiency, situational awareness, and ease of use of the prototype tool in a simulated environment. Two highly-qualified mentors with substantial experience in patient safety and informatics research will supervise training, which will include mentored research, formal coursework, directed readings, and seminars. The proposed activities will provide a foundation for electronic communication tool designs that improve situational awareness, efficiency, and ease of use. This will reduce delays in diagnosis from communication breakdowns and reduce provider EHR message processing burden, allowing more time for direct patient care.