Impact of Meaningful Use on Clinical Workflow in Emergency Departments

描述(由申请人提供)：电子健康记录(EHR)等健康信息技术的进步可以减轻临床医生的复杂性负担，潜在地提高医疗保健的质量、安全和效率。随着《美国复苏和再投资法案》(ARRA)中的卫生信息技术促进经济和临床卫生(HITECH)条款提供的财政激励，这些系统正在变得越来越普遍，它们对用户的接受性和临床环境中的影响也变得更加重要。我们提出了一种基于证据的实证方法来研究临床工作流程的三个特定关键要素：信息寻求、团队互动和临床医生使用电子病历的决策。虽然我们的实验重点是在急诊科(ED)使用EHR，但结果应该推广到其他临床环境，在这些环境中，EHR必须与临床工作流程相结合。在响应阶段2 MU标准的功能实施过程中，将使用一套五个临床质量和效率指标来评估临床医生使用与三个工作流程要素相关的EHR的情况。我们利用一套方法来捕捉、分析和描述EHR的影响，以便为未来符合MU的实施战略提供信息。我们的方法包括环境观察、临床医生跟踪、日志文件分析和基于射频识别(RFID)传感器的跟踪。这种以过程为导向的研究在两家城市医院的两个成人急诊科进行，并得到护理结果评估的支持，将指导开发更好地整合到临床社会结构中的通用设计指南。 环境。我们寻求的结果将有助于为改善EHR制定患者安全和质量指南，这些指南将适合纳入未来的MU阶段。这些结果还将为国家协调员办公室(ONC)和医疗保险和医疗补助服务中心(CMS)提供证据，以指导电子健康记录供应商不断演变的认证标准，以及未来促进有意义地使用电子健康记录的法规。

DESCRIPTION (provided by applicant): Advances in health information technology such as Electronic Health Records (EHRs) can reduce the burden of complexity on clinicians, potentially improving quality, safety, and efficiency of healthcare. With the financial incentives offered by the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA), which linked payments to the development of "Meaningful Use" (MU) criteria for EHRs, these systems are becoming more prevalent and their acceptability to users and impact in clinical contexts are of increased importance. We propose an evidence-based, empirical approach for investigating three specific critical elements of clinical workflow: information seeking, team interaction, and decision making in the context of clinicians' use of EHRs. Although we focus our experiments on the use of EHRs in emergency departments (EDs), the results should generalize to other clinical settings in which EHRs must be integrated with clinical workflow. Clinicians' use of EHRs in relation to the three workflow elements will be evaluated using a set of five clinical quality and efficiency metrics during the implementation of features in response to Stage 2 MU criteria. We utilize a set of methodologies to capture, analyze and characterize the impact of EHRs so as to inform future MU-compliant implementation strategies. Our methods include environmental observations, clinician shadowing, log-file analysis, and radio frequency identification (RFID) sensor-based tracking. Such process-oriented studies, conducted in two adult emergency departments at two urban hospitals, supported by the evaluation of care outcomes, will guide the development of generalizable design guidelines that are better integrated within the social fabric of the clinical environment. We seek results that will contribute to the development of patient-safety and quality guidelines for EHR improvement, which will be suitable for incorporation into future MU stages. These results will also provide the Office of the National Coordinator (ONC) and the Centers for Medicare & Medicaid Services (CMS) with evidence to guide the evolving certification criteria for EHR vendors, and future regulations promoting meaningful use of EHRs.