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Systems for Helping Veterans Comprehend Electronic Health Record Notes

帮助退伍军人理解电子健康记录笔记的系统

基本信息

批准号：
9894743
负责人：
HONG YU
金额：
--
依托单位：
EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-01 至 2019-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9894743
关键词：
Abbreviations Ambulatory Care Facilities Back Caring Clinical Cognitive Communication Communities Competence Comprehension Confusion Development Dictionary Documentation Educational Materials Electronic Health Record Ensure Evaluation Health Health Communication Health Educators Health Personnel Healthcare Individual Informatics Information Resources Intelligence Intervention Knowledge Lead Link Low income Maps Measurement Measures Medical MedlinePlus Motivation Myocardial Infarction Natural Language Processing Outcome Outcome Study Patient Care Patient-Centered Care Patient-Focused Outcomes Patients Perception Physicians Provider Randomized Research Research Design Research Personnel Resources Scientist Secure Self Determination Self Management System Testing Text Translating Trust Veterans Vocabulary Vulnerable Populations Work base care delivery care outcomes care providers comorbidity design empowerment health administration health information technology health knowledge health literacy implementation trial improved innovation literacy open source patient engagement patient portal prototype recruit service utilization skills study characteristics theories tool usability

项目摘要

DESCRIPTION (provided by applicant): The Veterans Health Administration (VHA) is committed to the sharing of Veteran's health information in its efforts to improve the patient-provider relationship in care delivery. The VHA has demonstrated this commitment with the initiation of MyHealtheVet (MHV) patient portal which also utilizes secure messaging between Veterans and their care teams as a way to improve communication. Clinical notes represent a key piece of patient information that could further enhance this relationship. In January 2013, the VA made Veterans' primary care provider's clinical notes available to their patients through the Blue Button feature within the MHV portal. Patient access to full text clinical notes has the potential to improve patient engagement and care. However, a recent study demonstrated that patients- especially those who are vulnerable (e.g., lower literacy, lower income)-can be perplexed by EHR notes. Inadvertently, this confusion and miscommunication may result in unintended increases in service utilization, and changes in perceptions that may disrupt patient-provider relationships. This proposal seeks to develop an innovative tool which will aid Veterans in the comprehension and effective use of their clinical notes to better their care outcomes. We will develop and evaluate NoteAid, a multi-component, intelligent natural language processing (NLP) system designed to translate medical jargon into consumer oriented concepts and provide "patient-friendly" links to related educational material from trusted resources. We expect that NoteAid will improve Veterans' comprehension of their EHR notes, which in turn will increase patient autonomy and self-management. No current HSR&D projects are evaluating this new innovation, and operational leaders are seeking guidance on how to further advance sharing of clinical information with Veterans. Our Specific Aims are to: Aim 1: Develop a comprehensive EHR health knowledge resource-NoteKnow. It will link medical concepts (e.g., myocardial infarction) to the corresponding consumer oriented concepts (e.g., heart attack), along with definitions and high-quality educational material. Aim 2: Develop, implement, and assess NoteAid, a system that will decipher EHR notes and link them to NoteKnow. NoteAid will integrate innovative NLP approaches. We will assess the NoteAid system using expert walkthrough, usability testing, and task-driven cognitive evaluation. Aim 3: Evaluate NoteAid in a randomized comparison study. We will recruit 250 Veterans from the Worcester VA outpatient clinic. The Veterans will be randomly assigned to two groups: 1.) use of standard EHR notes; 2.) use of EHR notes with NoteAid support. The Study outcomes will be guided by Self- Determination Theory, including: 1.) perceived autonomy support of NoteAid and, 2.) the effect of NoteAid on Veteran outcomes (e.g., motivation and competence). Our integrated research team will include Veterans, physicians, a health educator, informaticians, a biostatistician, and health literacy and communication scientists. We will employ Veterans as co-investigators throughout the NoteAid study to ensure our focus on the end-user. Veterans will be engaged at multiple levels, including intervention refinement (usability tests) and creation (Veteran generated content). In both Aims 1 and 2, Veterans will drive the excellence of the NoteAid system, maximizing the potential of the system to support user comprehension in Aim 3. NoteAid will be a stand-alone and open-source tool that will be made available to national health IT organizations, healthcare providers and patients at the completion of this study. The potential impact of this system is high.

描述(由申请人提供)：退伍军人健康管理局(VHA)致力于共享退伍军人的健康信息，努力改善医疗服务中的患者与提供者的关系。VHA通过启动MyHealtheVet(MHV)患者门户网站证明了这一承诺，该门户网站还利用退伍军人及其护理团队之间的安全消息传递作为改善沟通的一种方式。临床记录代表了一条关键的患者信息，可以进一步加强这种关系。2013年1月，退伍军人管理局通过MHV门户网站内的蓝色按钮功能向患者提供退伍军人初级保健提供者的临床记录。患者访问全文临床记录具有提高患者参与度和护理的潜力。然而，最近的一项研究表明，患者--特别是那些易受伤害的人(例如，低识字率、低收入)--可能会被电子病历所困扰。不经意间，这种混淆和沟通可能会导致服务利用率的意外增加，以及可能扰乱患者与提供者关系的认知变化。这项建议旨在开发一种创新的工具，帮助退伍军人理解和有效使用他们的临床笔记，以改善他们的护理结果。我们将开发和评估Noteaid，这是一个多组件的智能自然语言处理(NLP)系统，旨在将医学术语转换为面向消费者的概念，并提供来自可信资源的相关教育材料的“患者友好”链接。我们预计NoteAid将提高退伍军人对电子病历记录的理解，这反过来将增加患者的自主性和自我管理。目前还没有任何HSR&D项目正在评估这一新的创新，运营领导人正在寻求如何进一步推进与退伍军人共享临床信息的指导。我们的具体目标是：目标1：开发一个全面的EHR健康知识资源-NoteKnow。它将把医学概念(如心肌梗死)与相应的面向消费者的概念(如心脏病发作)以及定义和高质量的教育材料联系起来。目标2：开发、实施和评估Noteaid，这是一个将破译EHR笔记并将其链接到NoteKnow的系统。Noteaid将整合创新的NLP方法。我们将使用专家演练、可用性测试和任务驱动的认知评估来评估Noteaid系统。目的3：在随机比较研究中评估Noteaid。我们将从伍斯特退伍军人管理局门诊招募250名退伍军人。退伍军人将被随机分配到两组：1.使用标准的电子健康记录；2.)通过Noteaid支持使用电子病历笔记。研究结果将以自决理论为指导，包括：1)Noteaid和2的自主支持感。)Noteaid对退伍军人结果的影响(例如，动机和能力)。我们的综合研究团队将包括退伍军人、医生、健康教育者、信息学家、生物统计学家以及健康素养和传播科学家。在整个Noteaid研究中，我们将聘请退伍军人作为联合调查员，以确保我们将重点放在最终用户上。老兵将在多个层面上参与，包括干预改进(可用性测试)和创作(老兵生成的内容)。在目标1和目标2中，退伍军人将推动Noteaid系统的卓越，最大限度地发挥该系统在目标3中支持用户理解的潜力。Noteaid将是一个独立的开源工具，将在本研究完成后提供给国家卫生IT组织、医疗保健提供者和患者。这一制度的潜在影响很大。