Diagnostic Accuracy through Advancing EHR displaY, Education and Surveillance (DATA-EYES)

通过推进 EHR 显示​​、教育和监视来提高诊断准确性 (DATA-EYES)

• 批准号: 10640782
• 负责人: DAVID W., MD,Msc BATES
• 金额: $ 100万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640782
• 关键词: Diagnostic; Accuracy; through; Advancing; EHR

Project Summary: Diagnostic error (DE) remains one of the most costly and prevalent forms of preventable medical error, with nearly 12 million Americans affected annually at an estimated cost of over $100 billion. Unfortunately, efforts to reduce DE have remained largely unsuccessful. This is in large part due to the fact that etiology of DE is highly complex with multiple contributing factors. However, central to the diagnostic process are critical cognitive processes such as the physician's ability to find and process relevant information, reason with this information, and formulate a diagnosis. With over 95% of healthcare providers adopting electronic health records (EHRs), these systems are the primary source of nearly all patient information and, therefore, shape the diagnostic process. While it is recognized that the EHR contributes to the problem of DE, the identification and relative contribution of how, when and why the EHR contributes to DE, specifically as it relates to the sociotechnical domains of software, user and system (workflow) are poorly described. We have attempted to better define this through the analysis of medical malpractice cases (CRICO) and patient safety event (PSE) report forms related to DE in ambulatory care. From our medical malpractice analysis, nearly 60% of cases of DE had a definitive EHR contribution, with another 19% indeterminate. The EHR contributed most often during the testing phase of the diagnostic process with the most common EHR hazards related to data interpretation, order placement and execution of plan. However, this analysis relies on manual evaluation of unstructured data which is highly time consuming, lacks specificity and is impractical for widespread adoption. Once the relative contribution of EHRs to DE can be determined, health systems can then deploy solutions to help mitigate. Ideally this will include the ability to use simulation to guide both EHR redesign and training, in situ observation of how the EHR integrates into daily workflow and a strategy to monitor the impact of these interventions. The goal of this proposal is to establish a Diagnostic Center of Excellence (DATAEYES) focused on identification of EHR contribution to DE, and use this information to deploy a suite of solutions to improve software, user and system. We will achieve this by using national data to create an informed taxonomy to be integrated into institution data collection tools, to facilitate institution-wide capture of EHR contributions to DE in Aim #1. We will then develop and validate these tools in Aim #2 and use this information, in combination with in situ workflow observations, to inform how, when and why the EHR is contributing to DE. This information will be used to create high- fidelity simulated EHR charts to facilitate both workflow specific training on EHR best practices and guide EHR redesign and monitor the impact of these interventions via EHR audit logs in Aim #3. The 3 centers participating (OHSU, Medstar Health, Brigham and Women's Hospital) will allow further ascertainment of the impact of both EHR vendors being studied (Cerner and Epic) and local workflow specific practices. We will then leverage our collaborations with patient safety organization and industry to disseminate these findings and the infrastructure developed at DATAEYES will serve as a core resource for the other DCE sites, allowing for rapid evaluation and prototyping of future EHR based solutions.

项目概要： 诊断错误 (DE) 仍然是可预防的医疗错误中成本最高且最普遍的形式之一，几乎 每年有 1200 万美国人受到影响，估计损失超过 1000 亿美元。不幸的是，减少 DE 的努力并没有取得进展。 基本上仍然不成功。这在很大程度上是由于 DE 的病因非常复杂，涉及多种因素。 影响因素。然而，诊断过程的核心是关键的认知过程，例如医生的认知过程 查找和处理相关信息、利用这些信息进行推理并做出诊断的能力。超过95% 的医疗保健提供者采用电子健康记录 (EHR)，这些系统是几乎所有信息的主要来源 患者信息，从而塑造诊断过程。虽然人们认识到电子病历有助于 DE 问题，EHR 如何、何时以及为何对 DE 做出贡献的识别和相对贡献，具体而言 由于它涉及软件的社会技术领域，因此对用户和系统（工作流程）的描述很少。我们有 试图通过对医疗事故案例（CRICO）和患者安全事件（PSE）的分析来更好地定义这一点 与门诊护理中的 DE 相关的报告表格。根据我们的医疗事故分析，近 60% 的 DE 病例有 确定的 EHR 贡献，还有 19% 不确定。 EHR 在测试阶段贡献最多 诊断过程中最常见的 EHR 危险与数据解释、订单下达和 计划的执行。然而，这种分析依赖于非结构化数据的手动评估，这非常耗时， 缺乏特异性，不适合广泛采用。一旦 EHR 对 DE 的相对贡献可以 确定后，卫生系统就可以部署解决方案来帮助缓解。理想情况下，这将包括使用模拟的能力 指导 EHR 重新设计和培训，现场观察 EHR 如何融入日常工作流程和策略 监测这些干预措施的影响。该提案的目标是建立卓越诊断中心 (DATAEYES) 专注于识别 EHR 对 DE 的贡献，并使用此信息部署一套解决方案 改进软件、用户和系统。我们将通过使用国家数据创建一个知情的分类法来实现这一目标 集成到机构数据收集工具中，以促进整个机构捕获 EHR 对目标 1 中 DE 的贡献。 然后，我们将在目标 #2 中开发和验证这些工具，并结合现场工作流程使用这些信息 观察，以告知 EHR 如何、何时以及为何对 DE 做出贡献。该信息将用于创建高 保真模拟 EHR 图表，以促进 EHR 最佳实践的工作流程特定培训并指导 EHR 重新设计 并通过目标 3 中的 EHR 审计日志监控这些干预措施的影响。参与的 3 个中心（OHSU、Medstar 卫生部门、布莱根妇女医院）将进一步确定正在研究的两家电子病历供应商的影响 （Cerner 和 Epic）和本地工作流程特定实践。然后，我们将利用与患者安全的合作 组织和行业传播这些发现，DATAEYES 开发的基础设施将作为核心 其他 DCE 站点的资源，允许对未来基于 EHR 的解决方案进行快速评估和原型设计。