Understanding Provider Workflow Needs in Electronic Communication

描述(由申请者提供)：该奖项的目的是让我获得必要的培训、指导和经验，以成为患者安全和信息学方面的独立卫生服务研究员。我的最终目标是发展成为一名学术领袖，使用多学科科学来提高与基于电子健康记录(EHR)的通信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名患者安全和信息学卫生服务研究员工作所必需的技能。我将利用这个奖项提供的受保护时间，在三个主要领域获得培训和经验：评估工作流程的技术、定性研究方法和人为因素原则。由于提供者之间的沟通中断而导致的诊断和治疗延误是医疗保健中的一个常见问题，并导致不利的患者结果和医疗事故诉讼。在最近的一份医疗研究和质量特别强调通知(NOT-HS-13-009)中，强调了确定防止此类延误的策略的重要性。我将在我们团队工作的基础上再接再厉，揭示尽管提供商越来越多地使用基于电子健康记录(EHR)的工具来管理通信，但这些延迟仍然存在。许多因素被认为是造成这种延误的原因，但其中三个是经常发生的，经过充分研究，是干预的理想目标。这些问题包括向供应商发送的大量信息造成信息过载，缺乏基于电子病历的通信工具来促进对情况的认识，以及现有电子通信工具使用不便，从而导致信息处理效率低下。在提出的研究中，我将使用多学科方法对电子通信工具进行评估。具体地说，我将评估提供商用于管理电子消息的流程，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：评价供应商的非同步电子通信管理流程，以查明供应商效率和情景意识的促进者和障碍。目标2：开发一个可优化提供商效率、情景感知和易用性的异步电子通信原型工具。目标3：在模拟环境中评估原型工具的效率、情景感知和易用性。两名在患者安全和信息学研究方面拥有丰富经验的高素质导师将监督培训，培训将包括指导研究、正式课程作业、定向阅读和研讨会。拟议的活动将为电子通信工具的设计奠定基础，以提高对局势的认识、效率和易用性。这将减少因通信中断而导致的诊断延迟，并减轻提供商EHR消息处理负担，从而有更多时间进行直接患者护理。

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.