Advancing Health Information (HIE) During Inter-hospital Transfer (IHT) to Improve Patient Outcomes

摘要 经常进行急症护理医院之间的患者转移（医院间转移，IHT） 为患者提供转院医院无法提供的专业护理。超过100，000名医疗保健人员 患有多种慢性疾病的高发病率患者每年接受IHT。然而，IHT使患者暴露于 护理中断的风险，缺乏可能防止护理缺口的潜在保障措施， 通信我们之前对IHT的广泛研究表明， 包括沟通频繁和信息交流不足，高达35%的患者 转移时缺少基本临床信息。IHT期间的次优HIE与 患者伤害，如治疗错误和护理延误，并可能导致更高的死亡率 在选定的IHT患者中观察到。考虑到这种护理过渡的复杂性， 由于需要解决工作流程、数据可视化和互操作性的解决方案， 要有效率。 本研究的总体目标是利用我们在IHT和健康方面的广泛研究经验 信息技术创新，设计，实施和严格评估干预措施，以改善HIE 在IHT期间，在转移医院和接受医院之间具有不同整合水平的三个用例中： 同一卫生系统内的医院，共享同一EHR的不同系统内的医院，以及 不同系统的医院使用不同的EHR。为此，我们建议修订和推行 可互操作的HIE平台，提高了IHT期间必要临床信息的可靠性和访问。 我们将建立在我们以前的工作，确定必要的临床信息和数据可视化，以有效地 利用以用户为中心的设计，快速识别、设计、开发、改进和实施 来自跨专业用户的要求，包括临床医生和转移和接收人员 医院的HIE平台将使用可互操作的数据交换标准和API来无缝集成 与每个用例中的现有供应商EHR相结合。我们的团队将严格评估这一影响 使用中断时间干预患者安全结局，包括医疗错误和不良事件 系列方法，我们的团队将对利用率、感知 可用性，以及来自与 平台最后，这些数据将提交给具有护理过渡专业知识的指导委员会成员 和传播战略，以及参与医院的行政和卫生IT领导，以产生 就最佳做法提出意见，以便进一步完善和实施， 其他类似机构。

ABSTRACT The transfer of patients between acute care hospitals (inter-hospital transfer, IHT) is often undertaken to provide patients with specialized care that is unavailable at the transferring hospital. Over 100,000 Medicare patients with high rates of multiple chronic conditions undergo IHT annually. However, IHT exposes patients to the risks of discontinuity of care and lacks potential safeguards that might protect against gaps in communication. Our extensive prior work examining IHT demonstrates sub-optimal transfer processes, including frequent gaps in communication and inadequate information exchange, with up to 35% of patient transfers missing essential clinical information on transfer. Sub-optimal HIE during IHT has been associated with patient harm such as therapeutic errors and delays in care and may contribute to greater mortality observed among select IHT patients. Given the complexities of this care transition, effective HIE has proven difficult to achieve due to the need for solutions to address workflow, data visualization and interoperability to be effective. The overall goals of this study are to leverage our extensive research experience in IHT and health information technology innovation to design, implement, and rigorously evaluate an intervention to improve HIE during IHT in three use cases with different levels of integration between transferring and accepting hospitals: hospitals within the same health system, hospitals in different systems that share a common EHR, and hospitals in different systems that use different EHRs. To achieve this, we propose to refine and implement an interoperable HIE platform that improves reliability of and access to necessary clinical information during IHT. We will build on our prior work that identifies essential clinical information and data visualization for effective HIE during IHT, and utilize user-centered design to rapidly identify, design, develop, refine, and implement requirements from interprofessional users, including clinicians and personnel at transferring and accepting hospitals. The HIE platform will use interoperable, data exchange standards and APIs to seamlessly integrate with existing vendor EHRs within each use case. Our team will rigorously evaluate the impact of this intervention on patient safety outcomes, including medical errors and adverse events, using interrupted time series methodology, and our team will conduct robust mixed-methods evaluation on utilization, perceived usability, and facilitators and barriers to implementation from interprofessional users who interact with the platform. Finally, these data will be presented to steering committee members with expertise in care transitions and dissemination strategy, and executive and health IT leadership from participating hospitals, to generate input on best practices for further refinement and implementation to create a dissemination toolkit to share with other similar institutions.