Modeling and Optimization of Clinical Processes Using EHR Data

 描述(申请人提供)：这个K99/R00奖项的目标是应用生物医学信息学、运筹学和计算机科学的方法来开发、实施和评估激励和优化工具，以改进临床流程。这是一个重要的话题，因为电子健康记录(EHR)系统有可能提高医疗保健的质量和成本，但提供者担心电子健康记录的实施已经对现实世界的生产力和效率产生了负面影响。基于自动时间运动数据收集的改进工作流程的方法将对现实世界产生重大影响。这项提议包括两个阶段：(A)K99培训和指导研究阶段，这将包括俄勒冈健康与科学大学(OHSU)和波特兰州立大学(OHSU)的高级运筹学研究和分析技术培训。在两名经验丰富的信息学家和临床医生、一名统计学家和一名系统工程师的指导下，这项培训将应用于改善临床工作流程的研究。K99阶段的研究将集中于研究眼科门诊工作流程和整个项目的前两个具体目标：(SA#1)开发基于EHR时间戳和室内定位系统的自动时间运动工作流数据收集工具，(SA#2)创建模拟模型以提高临床工作流程的效率，并通过在眼科门诊诊所测试这些模型来验证这些模型。眼科将是进行这些初始工作流程研究的理想临床领域，因为它是一种快节奏的门诊专科，包括内科和外科患者、成像测试、多个检查阶段(例如，扩眼前后)和多个辅助工作人员(例如，技术人员、摄影师)。(B)R00研究阶段和向独立的过渡。R00阶段的研究将集中于整个项目的第三个具体目标：(SA#3)开发、实施和评估更广泛的住院和门诊医疗领域的数据收集、模拟和建模技术。这将通过收集EHR数据(例如，手术类型、住院时间、人口统计数据)来创建表示患者对资源的需求的概率密度函数，从而概括指导项目阶段的方法。这些数据将用于开发基于患者分类的不同调度策略的模拟模型，并在临床环境中进行评估。这个项目将受益于一位在数学和计算机科学方面拥有强大背景的PI，一支优秀的合作导师团队，他们在拟议项目的所有领域都有互补的经验，以及OHSU出色的学术信息学环境。

 DESCRIPTION (provided by applicant): The goal of this K99/R00 award is to apply methods from biomedical informatics, operations research, and computer science to develop, implement, and evaluate stimulation and optimization tools for improving clinical processes. This is an important topic because electronic health record (EHR) systems have potential to improve quality and cost of health care, yet providers have raised concerns that EHR implementation has negatively impacted real-world productivity and efficiency. Methods for improving workflow based on automated time-motion data collection will have significant real-world impact. This proposal involves two phases: (A) K99 training and mentored research phase, which will include training in advanced operations research and analytics techniques at Oregon Health & Science University (OHSU) and Portland State University. Under the mentorship of two experienced informaticians and clinicians, a statistician, and a systems engineer, this training will be applie to research in improving clinical workflows. The K99 phase of research will focus on studying ophthalmology outpatient clinic workflows and the first two Specific Aims of the overall project: (SA#1) Develop tools for automated time-motion workflow data collection tools based on EHR timestamps and indoor positioning systems and (SA#2) Create simulation models to improve the efficiency of clinical workflow and validate these models by testing them in ophthalmology outpatient clinics. Ophthalmology will be an ideal clinical domain for performing these initial workflow studies because it is a fast-paced ambulatory specialty that includes medical and surgical patients, imaging tests, multiple examination stages (e.g., before & after eye dilation), and multiple ancillary staff members (e.g., technicians, photographers). (B) R00 research phase and transition to independence. The R00 phase of research will focus on the third Specific Aim of the overall project: (SA#3) Develop, implement, and evaluate data collection, simulation, and modeling techniques to broader inpatient and outpatient medical domains. This will generalize methods from the mentored project phase by collecting EHR data (e.g., surgery type, length of inpatient stay, demographics) to create probability density functions representing patient demand for resources. These data will be used to develop simulation models for different scheduling strategies based on patient classifications, and to evaluate them in the clinical setting. This project will benefit from a PI who has a strong background in mathematics and computer science, from an outstanding collaborative team of mentors with complementary experience across all areas of the proposed project, and from an outstanding academic informatics environment at OHSU.