A Turn-Key EHR Simulation Program to Reduce Diagnostic Error in Ambulatory Care

交钥匙 EHR 模拟程序可减少门诊护理中的诊断错误

• 批准号: 10242662
• 负责人: JEFFREY A. GOLD
• 金额: $ 38.54万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242662
• 关键词: Turn; Key; EHR; Simulation; Program

Project Summary: Diagnostic error is believed to be the most common type of patient safety event. Affecting between 5-10% of all patient encounters, it results in significant patient morbidity and mortality. Ambulatory care is especially susceptible to this, with diagnostic errors outnumbering other types 6:1 and 5% of patients seeking ambulatory care experiencing diagnostic error. Comprised of delayed and missed diagnosis, diagnostic error is frequently the consequence of the inability to effectively access and/or synthesize complex medical information for medical decision making. With the adoption of the HITECH Act over 95% of hospitals and 80% of office based practice utilize Electronic Health Records (EHRs) as their primary source of patient information. With the rapid expansion of EHRs, there is growing appreciation of the myriad of ways in which EHRs contribute to failures in information gathering and/or synthesis. These EHR use errors are often a combination of system design issues and poor user training. Simulation affords a powerful tool to both study, in a systematic way, the means in which EHRs contribute to said errors as well as provide a powerful training tool. We previously demonstrated that hi-fidelity EHR based simulation exercises in the ICU, using purposively designed EHR charts, uncovers the contribution of EHR use errors to diagnostic error. Participation in these exercises improves the recognition of embedded trends in patient information required for effective diagnostic accuracy by 50%. While we have created a number of simulation based exercises for critical care, the workflow, cognitive errors and EHR chart structure are fundamentally different for ambulatory care, representing a greater degree of longitudinal care and the need to process information acquired across multiple individual encounters. This places even more importance on information loss during transitions of care. Further, a number of barriers exist to implementation of EHR based simulation activities at most medical centers, an issue magnified in community practices. Therefore the goal of this proposal is to create and validate a turn-key library of EHR based simulations to improve diagnostic safety in ambulatory care which is both generalizable and scalable. In Aim #1, we will perform our problem analysis by using a combination of administrative data from the Pennsylvania Patient Safety Authority and claims data from The Doctors Company to identify diagnoses at risk for diagnostic error in ambulatory care and EHR use errors associated with said errors. We will integrate these data to create a rubric to allow for the design of a comprehensive EHR based simulation library to study and reduce diagnostic error across the 5 major ambulatory specialties. In Aim #2, we will develop these simulations for 5 ambulatory specialties. We will in-turn validate the ability of the simulation activities to serve as a training tool to fundamentally change EHR use patterns and reduce diagnostic error. Finally, this library, including all simulation materials, scripts and EHR charts will be coalesced into an online repository in Aim #3. We will further create a series of FHIR based applications which will facilitate “loading” of the simulated EHR charts into the major EHR systems. Thus, by the end of the funding period, we will have created a library of validated EHR base simulation exercises to reduce diagnostic error in ambulatory care and developed novel technology to facilitate widespread implementation.

项目总结：诊断错误被认为是最常见的患者安全性事件类型。影响之间 占所有患者就诊的5-10%，导致显著的患者发病率和死亡率。门诊护理尤其是 易受此影响，诊断错误的数量超过其他类型的6：1和5%的患者寻求门诊护理 出现诊断错误。包括延误和漏诊，诊断错误往往是 无法有效地访问和/或综合复杂的医疗信息以进行医疗决策的后果 制作。随着HITECH法案的通过，超过95%的医院和80%的基于办公室的实践使用电子 健康记录（EHR）作为患者信息的主要来源。随着电子健康档案的迅速发展， 认识到电子健康记录导致信息收集和/或综合失败的无数方式。这些 EHR使用错误通常是系统设计问题和用户培训不足的组合。模拟提供了一个强大的 一个工具，既研究，在一个系统的方式，在EHR有助于上述错误的手段，以及提供一个强大的 培训工具。我们以前证明了高保真EHR为基础的模拟演习在ICU，使用有目的的 设计的EHR图表，揭示了EHR使用错误对诊断错误的贡献。参加这些活动 将有效诊断准确性所需的患者信息中嵌入趋势的识别能力提高了50%。 虽然我们已经为重症监护创建了一些基于模拟的练习，但工作流程、认知错误和EHR 图表结构与门诊护理有根本的不同，代表了更大程度的纵向护理， 需要处理在多次单独遭遇中获得的信息。这就更加重视 护理过渡期间的信息丢失。此外，基于电子健康记录的实施存在许多障碍， 模拟活动在大多数医疗中心，一个问题在社区实践中放大。因此， 一项建议是创建和验证一个基于EHR的模拟交钥匙库，以提高门诊诊断安全性 护理既可推广又可扩展。在目标#1中，我们将使用组合来执行问题分析， 宾夕法尼亚州患者安全管理局的行政数据和医生公司的索赔数据， 识别门诊护理中存在诊断错误风险诊断以及与所述错误相关联的EHR使用错误。我们将 整合这些数据，创建一个规则，以便设计一个全面的基于EHR的仿真库来研究 并减少5个主要门诊专科的诊断错误。在目标#2中，我们将开发这些模拟， 5门诊专科。我们将反过来验证模拟活动作为培训工具的能力， 从根本上改变EHR使用模式，减少诊断错误。最后，这个库，包括所有的模拟 材料、脚本和EHR图表将合并到目标3的在线存储库中。我们将进一步创造一系列 基于FHIR的应用程序，这将有助于“加载”模拟EHR图表到主要的EHR系统。因此，由 在资助期结束时，我们将创建一个经过验证的EHR基础模拟练习库， 诊断错误的门诊护理和开发新的技术，以促进广泛实施。