Clinical Information Needs of CHCs for HIT (CLINCH-IT)

 描述（由申请人提供）：当为具有多种身体、精神和社会需求的复杂患者提供服务时，管理患者信息可能特别困难，并且通常由多名医疗保健专业人员进行检查。在协调此类患者的护理时，初级保健临床医生及其工作人员必须定位、获得和综合评估患者、做出临床决策、监测进展和确定护理目标所需的广泛信息。他们还必须确定参与患者护理的人员，并有效地共享信息，甚至与位于其他环境中的护理团队成员共享信息。卫生信息技术（卫生IT），最佳地支持有效的护理协调所需的信息访问，管理和共享，是解决这一复杂问题的关键 的信息需求。然而，虽然健康IT工具-特别是电子健康记录（EHR）-在初级保健实践中越来越普遍，但这些工具很少专门设计用于解决初级保健团队在为复杂患者提供和协调护理方面的信息管理需求。因此，这样的IT系统实际上可能会使护理碎片化、效率低下和变通方法永久化，从而导致错误和较低质量的护理。我们专注于确定临床医生和临床团队在照顾复杂患者人群时通常需要的临床相关信息，并研究临床团队如何使用健康IT来解决通常对其复杂患者的健康和医疗保健至关重要的社会和经济环境（称为健康的社会决定因素）。我们通过广泛的人种学评估和访谈确定了必须满足的信息需求，以确保复杂患者的有效护理协调，并采用最先进的以用户为中心的设计方法来快速开发和测试满足这些需求的健康IT工具。这项工作将与OCHIN，Inc.合作进行，一个非营利组织，因其健康IT创新及其庞大的社区健康中心（CHC）网络而获得全国认可。通过这种合作伙伴关系，我们将实现以下具体目标：目标1：确定CHC临床医生和临床团队在单独和协作协调复杂患者护理时的信息需求;目标2：确定CHC临床医生和临床团队对患者健康社会决定因素的信息需求，以及获得这些信息并将其整合到EHR中的方法，以便在护理复杂患者时为临床决策提供信息;以及目标3：确定设计原则;使用经过验证的开发方法，快速开发和测试卫生信息技术工具，以满足目标1和目标2中确定的卫生信息技术需求。我们的研究人群将包括10个CHC的临床医生和工作人员。这 这项研究将提供一套实践和可操作的设计原则，这些原则将被广泛传播，卫生信息技术工具将展示这些原则，并将准备在OCHIN网络和其他EHR用户中实施。

 DESCRIPTION (provided by applicant): Managing patient information can be particularly difficult when serving complex patients who have multiple physical, mental, and social needs, and are often seen by multiple health care professionals. When coordinating care for such patients, primary care clinicians and their staff must locate, obtain, and synthesize the wide range of information needed to assess patients, make clinical decisions, monitor progress, and identify care goals. They also must identify the people involved in the patient's care, and share information effectively, even with members of the care team located in other settings. Health information technology (health IT) that optimally supports the information access, management, and sharing required for effective care coordination is critical to addressing this complicated set of information needs. Yet while health IT tools - especially electronic health records (EHRs) - are becoming common in primary care practice, such tools are rarely designed specifically to address primary care teams' information management needs in the context of providing and coordinating care for complex patients. As a result, such IT systems can actually perpetuate care fragmentation, inefficiencies, and workarounds leading to errors and lower quality care. We focus on identifying the clinically relevant information that clinicians and clinical teams commonly need when caring for complex patient populations, and examine how clinical teams use health IT to address the social and economic circumstances that are often central to their complex patients' health and healthcare (known as social determinants of health). We identify the information needs that must be met to ensure effective care coordination for complex patients through extensive ethnographic assessment and interviews, and employ state-of-the-art user-centered design methods to rapidly develop and test health IT tools that address these needs. This work will be conducted in partnership with OCHIN, Inc., a non-profit organization nationally recognized for its health IT innovations, and its large network of Community Health Centers (CHCs). Through this partnership, we will undertake the following specific aims: Aim 1: Identify CHC clinicians' and clinical teams' information needs when they work individually and collaboratively to coordinate care for complex patients; Aim 2: Identify CHC clinicians' and clinical teams' information needs regarding patients' social determinants of health, and methods for obtaining this information and integrating it into the EHR so as to inform clinical decision-making when caring for complex patients; and Aim 3: Identify design principles; use proven development methods to rapidly develop and test health IT tools to meet the health IT needs identified in Aims 1 and 2. Our study population will include clinicians and staff at 10 CHCs. This study will provide a set of practice and actionable design principles that will be widely disseminated, and health IT tools that demonstrate these principles and will be ready for implementation in the OCHIN network and among other EHR users.