Demonstrating the potential for electronic health record interoperability to improve patient safety research of older adults over the acute episode of care.

项目总结 患有多种慢性病(MCC)的老年人经常住院，并面临不良事件的风险 (Ae)在护理的急性发作期间。跨不同医疗保健提供者的分散医疗服务在以下方面很常见 这会增加AEs的风险，特别是在患有未被认识到的老年疾病的老年患者中。 试图解决这些风险的患者安全研究受到现有数据的限制，而且往往缺乏 从健康系统外部的提供者访问电子健康记录(EHR) 研究。我们建议利用新兴的互操作性标准和公共政策，这些公共政策要求 采用，使患者能够定位、检索并与我们的研究团队共享他们的EHR。我们将成为合作伙伴 有两项研究将招募老年人，旨在减少急性护理期间的不良反应。这两项研究 有适合于同意参与者参加这项示范研究的时间表。为了实现我们的目标，我们将 利用并增强我们现有的数字基础架构(基于Web的应用程序和安全的后端云 技术)，这是我们在过去和正在进行的工作中开发和实施的。双方合作伙伴的领导力 研究将在这项工作中发挥重要作用，确保强有力的协调。在目标1中，我们将加强我们现有的 使用两个开源项目的数字基础设施。我们将利用科学同步的基础设施 (S4)采购项目(用于我们所有人的研究计划)，使患者能够使用HL7 FHIR服务 找到他们的电子病历并与研究团队分享。MCC e-Care计划项目将提供临床信息 模型和值集，确保收集的数据可用于研究和临床护理。用户 确定先前护理地点的需求和要求并与 研究团队将通过严格的以用户为中心的设计过程来吸引。在目标2中，我们将实施和 使用混合方法迭代优化目标1中定义的工作流。在目标3中，我们将开发分析方法 用于协调汇总的EHR数据和与我们的合作伙伴研究相关的指标。这些指标将反映 基于使用FHIR服务收集的电子病历数据的护理碎片化，包括未识别的老年人 通过对检索到的临床记录中的非结构化文本应用自然语言处理来识别症状。在……里面 目标4，我们将使用这些指标作为多变量回归模型中的风险因素，以评估它们对 我们合作伙伴研究的安全结果。这一分析将展示对护理的新评估如何 老年人群中常见的碎片化和条件导致了急性护理期间的急性呼吸综合征。 我们的专家顾问、顾问和软件开发人员将在所有临床和技术方面提供帮助 这项工作。我们的示范研究将产生关于如何使患者能够 收集他们的数据并与研究团队共享，以这种方式收集数据的最佳实践，以及 在与老年人相关的患者安全研究中使用这些数据的价值。最后，我们的贡献 将提供两个开放源码项目供广泛采用，以惠及其他研究。

PROJECT SUMMARY Older adults with multiple chronic conditions (MCCs) are often hospitalized and are at risk for adverse events (AE) during acute episodes of care. Fragmented care across different healthcare providers is common for these patients and increases risk of AEs, especially in elderly patients with unrecognized geriatric conditions. Patient safety research that attempts to address these risks are limited by available data and often lack of access to electronic health records (EHR) from providers external to the health system conducting the research. We propose leveraging emerging interoperability standards, and public policies that require their adoption, to empower patients to locate, retrieve, and share their EHRs with our research team. We will partner with two studies that will enroll older adults and aim to reduce AEs during acute care episodes. Both studies have timelines suitable to consenting participants for this demonstration study. To accomplish our aims, we will leverage and enhance our existing digital infrastructure (a web-based application and secure backend cloud technology) that we have developed and implemented in past and ongoing work. Leadership of both partner studies will play major roles in this work, ensuring strong coordination. In Aim 1, we will enhance our existing digital infrastructure using two open-source projects. We will leverage infrastructure from the Sync-for-Science (S4S) Procure project (used in the All Of Us Research Program) enabling patients to use HL7 FHIR Services to find and share their EHRs with research teams. The MCC e-Care Plan project will supply clinical information models and value sets, ensuring that data collected can be used for both research and clinical care. User needs and requirements for identifying prior sites of care and sharing EHR data from those sites with the research team will be elicited via a rigorous user-centered design process. In Aim 2, we will implement and iteratively refine workflows defined in Aim 1 using mixed methods. In Aim 3 we will develop analytic methods for harmonizing aggregated EHR data and metrics relevant to our partner studies. These metrics will reflect care fragmentation based on EHR data aggregated using FHIR services, including unrecognized geriatric syndromes identified by applying natural language processing to unstructured text in retrieved clinical notes. In Aim 4, we will use these metrics as risk factors in a multivariable regression model to assess their effect on the safety outcomes of our partner studies. This analysis will demonstrate how novel assessments of care fragmentation and conditions common in geriatric populations contribute to AEs during acute care episodes. Our expert advisors, consultants, and software developers will assist with all clinical and technology aspects of this work. Our demonstration study will produce foundational knowledge regarding how to empower patients to collect and share their data with research teams, best practices for collecting data in this manner, and the value of using such data in studies of patient safety that are relevant to older adults. Finally, our contributions to two open-source projects will be made available for broad adoption to benefit other studies.