Ambulatory Clinic Exam Room Design with Respect to Computing Devices to Enhance Patient Centeredness

项目摘要 虽然已经进行了大量的研究，电子健康记录（EHR）和健康的影响， 信息技术（HIT）对提供者-患者互动的影响，如何有效地 将这些工具集成到医疗环境中，同时保持以患者为中心的护理。我们提出了一个 多方法研究，调查和改善检查室和计算布局，以提高临床 工作流程和以病人为中心，这可能最终提高病人的安全，在退伍军人健康 管理（VHA）。具体目标是： 目标1：原型设计和评估重新设计的检查室布局与检查室计算 并将重新设计的布局与退伍军人健康中心当前的典型检查室布局进行比较 管理（VHA）。 目标2：优化重新设计的检查室布局，在现场诊所环境中实施，并与 目前设计的检查室在退伍军人事务部（VA）医疗中心。 为了实现目标1，我们提出了一个“人在回路”的模拟研究中心的人体工程学 路易斯维尔大学的实验室空间，以试点测试重新设计的检查室布局， 检查室的电脑在拟议的模拟研究中，可以证明改进的系统设计 通过对效率、准确性、工作量、以患者为中心、屏幕共享所花费的时间、 工作流集成和态势感知。这些测量中的每一个都将用于比较电流， 典型的检查室布局与模拟环境中重新设计的布局。 为了实现目标2，我们提出了一个试点实施的基础上，在现场诊所的实际病人就诊。我们 将收集以患者为中心、屏幕共享、工作流程整合和态势感知的措施 在重新设计的检查室和目前的检查室，以了解重新设计的 检查室布局现场临床研究的目的是收集额外的现场数据，以支持 从实验室模拟研究的结果，并最终有信心，我们的干预， 更大的研究，将支持广泛传播重新设计的检查室布局VHA范围。 通过这些目标，我们将完善并最终确定VHA的新检查室设计， 社会技术系统的观点。我们期望通过本研究所产生的知识将是可推广的 在不同的医疗保健组织中，加强以患者为中心的检查室 计算的

PROJECT SUMMARY Although much research has been conducted on the impact of the electronic health record (EHR) and health information technology (HIT) on provider-patient interaction, challenges persist on how to effectively integrate these tools into healthcare environments, while maintaining patient-centered care. We propose a multi-method study to investigate and improve the exam room and computing layout to improve clinical workflow and patient-centeredness, which may ultimately enhance patient safety, in the Veterans Health Administration (VHA). The Specific Aims are: Aim 1: Prototype and evaluate a redesigned exam room layout with respect to the exam room computing and compare the redesigned layout to a current, typical exam room layout in the Veterans Health Administration (VHA). Aim 2: Refine the redesigned exam room layout, implement it in a live clinic setting, and compare it to currently designed exam rooms in a Veterans Affairs (VA) Medical Center. To achieve Aim 1, we propose a “human in the loop” simulation study in the Center for Ergonomics laboratory space at the University of Louisville to pilot test a redesigned exam room layout with respect to the exam room computing. In the proposed simulation study, improved system design can be demonstrated through measures of efficiency, accuracy, workload, patient-centeredness, time spent screen sharing, workflow integration, and situation awareness. Each of these measures will be used to compare a current, typical exam room layout with the redesigned layout in a simulated setting. To achieve Aim 2, we propose a pilot implementation based upon actual patient visits in a live clinic. We will collect measures of patient-centeredness, screen sharing, workflow integration, and situation awareness in both the redesigned exam room and current exam rooms to understand the impact of the redesigned exam room layout. The intention of the live clinic study is to gather additional field data to support the findings from the laboratory simulation study, and ultimately to have confidence our intervention for a larger study that would support broad dissemination of the redesigned exam room layout VHA-wide. Through these aims, we will refine and finalize a new exam room design for the VHA grounded in a sociotechnical systems perspective. We expect the knowledge generated by this study will be generalizable across different healthcare organizations for enhancing patient-centeredness with regard to exam room computing.