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

使用模拟来提高电子健康记录的使用和安全性

• 批准号: 8698771
• 负责人: JEFFREY A. GOLD
• 金额: $ 35万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8698771
• 关键词: Use; Simulation; improve; use; safety

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.

描述（由申请人提供）：2009 年，《美国康复与救济法案》(ARRA) 的目标是到 2014-15 年普遍采用电子健康记录 (EHR)。这是基于电子病历改善沟通、创建真正便携式医疗记录和提高患者整体安全的感知能力，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) 的 EHR 安全报告所强调的那样，人们越来越认识到 EHR 的使用会产生许多意想不到的后果，这实际上可能会增加医疗错误，在某些情况下还会增加患者死亡率。该报告给予 EHR 整体安全性 C+ 等级。 EHR 使用错误的增加归因于与数据发现、对沟通的不利影响和认知错误相关的问题，所有这些问题都因 EHR 用户界面和次优培训的问题而加剧。这些问题在重症监护室 (ICU) 得到了最好的描述，其中时间点和纵向数据密度、患者敏锐度、警觉疲劳以及紧急决策的需要将这些问题带到了最前沿。因此，我们假设高保真 EHR 模拟培训将能够识别潜在 EHR 使用错误的程度，提供改进 EHR 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 EHR 培训和重新设计。模拟 5 天医疗 ICU 患者的初步数据显示，日常用户仅正确识别了案例中 40% 的错误和患者安全问题，从而确定了问题的范围。在本提案中，我们计划 1. 扩展我们最初的 EHR 模拟站，以进行稳健的可用性分析（通过视频眼动追踪和按键记录），并创建更多案例以在 MICU 和其他 ICU 环境中进行扩展，2. 确定重复测试是否可以改善 ICU 内的 EHR 使用和错误识别，3. 利用可用性数据重新设计 EHR 培训和用户界面，4. 召开共识会议，确定 EHR 培训和用户界面的角色。 EHR 模拟可改善使用、教育和设计。

项目成果

Intelligent Simulation Model To Facilitate EHR Training.

智能仿真模型促进 EHR 培训。

• 发表时间: 2015
• 期刊: AMIA ... Annual Symposium proceedings. AMIA Symposium
• 作者: Mohan,Vishnu;Scholl,Gretchen;Gold,JeffreyA
• 通讯作者: Gold,JeffreyA

Integrating the Electronic Health Record into high-fidelity interprofessional intensive care unit simulations.

将电子健康记录集成到高保真跨专业重症监护病房模拟中。

• DOI: 10.3109/13561820.2015.1063482
• 发表时间: 2015
• 期刊: Journal of interprofessional care
• 影响因子: 2.7
• 作者: Gold,JeffreyA;Tutsch,AlyciaSR;Gorsuch,Adriel;Mohan,Vishnu
• 通讯作者: Mohan,Vishnu

A 5-day intensive curriculum for interns utilizing simulation and active-learning techniques: addressing domains important across internal medicine practice.

• DOI: 10.1186/s13104-018-4011-4
• 发表时间: 2018-12-21
• 期刊: BMC research notes
• 影响因子: 1.8
• 作者: Dversdal, Renee K;Gold, Jeffrey A;Desai, Sima S
• 通讯作者: Desai, Sima S

Frequency of Passive EHR Alerts in the ICU: Another Form of Alert Fatigue?

• DOI: 10.1097/pts.0000000000000270
• 发表时间: 2019-09-01
• 期刊: JOURNAL OF PATIENT SAFETY
• 影响因子: 2.2
• 作者: Kizzier-Carnahan, Vanessa;Antis, Kathryn A.;Gold, Jeffrey A.
• 通讯作者: Gold, Jeffrey A.

Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference.

使用模拟改善电子健康记录的使用、临床医生培训和患者安全：共识会议的建议。

• 发表时间: 2016
• 期刊: AMIA ... Annual Symposium proceedings. AMIA Symposium
• 作者: Mohan,Vishnu;Woodcock,Deborah;McGrath,Karess;Scholl,Gretchen;Pranaat,Robert;Doberne,JulieW;Chase,DianA;Gold,JeffreyA;Ash,JoanS
• 通讯作者: Ash,JoanS