Use of Simulation to improve use and safety of Electronic Health Records

描述（由申请人提供）：2009年，美国恢复和救济法案（ARRA）的目标是到2014-15年普遍采用电子健康记录（EHRs）。这是基于人们认为电子病历能够改善沟通、创建真正的便携式医疗记录和提高整体患者安全，特别是通过减少药物订购和管理中的错误。然而，正如2011年医学研究所（IOM）关于电子病历安全的报告所强调的那样，人们越来越意识到，使用电子病历会产生许多意想不到的后果，这实际上可能会增加医疗差错，在某些情况下还会增加患者死亡率。这份报告给电子病历的整体安全性评分为C+。电子病历使用错误的增加归因于与数据发现相关的问题，对沟通和认知错误的不利影响，所有这些都因电子病历用户界面问题和次优培训而加剧。这些问题在重症监护室（ICU）得到了最好的描述，在那里，时间点和纵向数据密度、患者敏锐度、警觉性疲劳和紧急决策需要将这些问题带到最前沿。因此，我们假设，高保真度的电子病历模拟培训将能够识别潜在的电子病历使用错误的程度，提供改进电子病历使用的方法，并作为迭代过程的框架，以改进我们机构内的全球电子病历培训和重新设计。模拟5天ICU患者的初步数据表明，日常用户正确识别病例中仅40%的错误和患者安全问题，定义了问题的范围。在这个提案中，我们计划1。扩展我们最初的EHR模拟站，以允许强大的可用性分析（通过视频眼球跟踪和按键记录），并创建额外的案例，以扩展在MICU和其他ICU环境中的应用。为了确定重复测试是否可以提高ICU内电子病历的使用和错误识别。3 .利用可用性数据重新设计电子病历培训和用户界面；召开一次共识会议，确定电子病历模拟的作用，以改进使用、教育和设计。

DESCRIPTION (provided by applicant): In 2009, the Americans Recovery and Relief Act (ARRA) targeted universal adoption of Electronic Health Records (EHRs) by 2014-15. This is based on the perceived ability of EHRs to improve communication, create truly portable medical records and improve overall patient safety, especially through reducing errors in medication ordering and administration. However, there is a growing awareness, as highlighted in the 2011 Institute of Medicine (IOM) report on EHR safety, that there are many unintended consequences to EHR use, which may in turn actually increase medical errors and in some instances increase patient mortality. This report gave overall EHR safety a grade of C+. The increase in errors with EHR use are attributed to issues related to data-findings, adverse effects on communication and cognitive errors, all of which are accentuated through problems with the EHR- user interface and sub-optimal training. These issues have been best described in the Intensive Care Unit (ICU), where point in time and longitudinal data density, patient acuity, alert fatigue and need fo urgent decision making bring these issues to the forefront. Consequently, we hypothesized that high- fidelity EHR simulation training would be able to identify the extent for potential EHR use errors, provide a means for improved EHR use and serve as a framework for an iterative process to improve global EHR training and redesign within our institution. Preliminary data with a simulated 5-day Medical ICU patient documented that daily users correctly identified only 40% of errors and patient safety issues within a case, defining the scope of the problem. In this proposal, we plan to 1. Expand our initial EHR simulation station to allow for robust usability analysis (through video eye-tracking and key logging) and create additional cases to expand both in the MICU and other ICU environments, 2. To determine whether repeated testing can improve EHR use and error recognition within the ICU, 3. To employ usability data to redesign EHR training and user interface and 4. To convene a consensus conference to establish the role for EHR simulation to improve use, education and design.