Connected Cancer Care: EHR Communication Networks in Virtual Cancer Care Teams

摘要 电子健康记录（EHR）系统的广泛采用正在改变医疗保健专业人员 （HCP）提供护理并相互沟通。尽管有证据表明，电子病历的使用 与增加对指南的依从性、加强临床监测和减少药物治疗有关 错误，EHR的使用对HCP之间的沟通和团队合作的影响还没有得到很好的理解。一个主要 挑战是，大多数护理团队都是虚拟团队，很难研究或改进他们的做法， 传统方法。本项目的目标是开发测量EHR通信的方法 网络，定义为虚拟护理团队中HCP之间基于EHR的信息共享连接， 研究EHR通信网络和护理质量之间的关系。 我们将讨论两个具体目标。第一个目标是开发和比较测量EHR的方法 乳腺癌、结直肠癌和非小细胞肺癌患者虚拟护理团队的通信网络。 我们将从弗吉尼亚联邦大学卫生系统的EHR系统中提取数据， HCP之间的EHR通信网络，这些HCP在诊断时间和 完成第一个疗程。我们将使用三种方法来构建时态EHR 通信网络：加权和定向网络，指数阈值网络， 多变量标记Hawkes过程我们将比较不同方法构建的网络。的 第二个目标是检查EHR通信网络结构和患者结果之间的关联， 包括30天再次入院和急诊科（艾德）就诊、1年住院和艾德使用率 服务和一年死亡率。我们将应用适当的统计技术（广义线性混合 模型）来分析通信网络结构和后续患者之间的关联 结果，根据患者特征和合并症进行调整。 我们希望这个项目将为未来的研究和质量改进工作奠定基础， 释放使用EHR数据的巨大潜力，以了解虚拟环境中的复杂通信活动 护理团队和设计基于团队的干预措施，从而加快改善护理的进展 通过使用卫生信息技术提高质量和成果。

ABSTRACT The widespread adoption of electronic health records (EHR) systems is changing how healthcare professionals (HCPs) deliver care and communicate with each other. Although evidence suggests that EHR use was associated with increased adherence to guidelines, enhanced clinical surveillance, and decreased medication errors, the impact of EHR use on communication and teamwork among HCPs is not well understood. A major challenge is that most care teams are virtual teams that are difficult to study or improve their practice using traditional methods. The objective of this project is to develop methods for measuring EHR communication networks, defined as EHR-based information sharing connections among HCPs, in virtual care teams and examine the relationship between EHR communication networks and care quality. We will address two specific aims. The first aim is to develop and compare methods for measuring EHR communication networks in virtual care teams for breast, colorectal, and non-small cell lung cancer patients. We will extract data from the Virginia Commonwealth University Health System's EHR system to construct EHR communication networks among HCPs who provide care to a patient between the time of diagnosis and completion of the first-course treatment. We will use three methods for constructing the temporal EHR communication networks: the weighted and directed network, the exponential-threshold network, and the multivariate marked Hawkes process. We will compare networks constructed from different methods. The second aim is to examine associations between EHR communication network structures and patient outcomes, including 30-day re-admissions and emergency department (ED) visits, one-year utilization of inpatient and ED services, and one-year mortality. We will apply appropriate statistical techniques (generalized linear mixed models) to analyze associations between communication network structures and subsequent patient outcomes, adjusted for patient characteristics and comorbidities. We expect that this project will build a foundation for future research and quality improvement efforts to unleash the enormous potential of using EHR data to understand complex communication activities in virtual care teams and design team-based interventions, leading to accelerated progress towards improving care quality and outcomes through the use of health information technology.