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

项目总结 尽管已经对电子健康记录(EHR)和健康的影响进行了大量研究 信息技术(HIT)在提供者和患者之间的互动，挑战仍然存在于如何有效地 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 多方法研究改进检查室和计算机布局，提高临床水平 工作流程和以患者为中心，这可能最终增强退伍军人健康中的患者安全 管理(VHA)。具体目标是： 目标1：根据考场计算对重新设计的考场布局进行原型和评估 并将重新设计的布局与退伍军人健康杂志目前的典型检查室布局进行比较 管理(VHA)。 目标2：改进重新设计的检查室布局，在现场诊所环境中实施，并将其与 目前在退伍军人事务部(VA)医疗中心设计的检查室。 为了实现目标1，我们在人体工程学中心提出了一项“人在回路中”的模拟研究 路易斯维尔大学的实验室空间，以试行测试重新设计的考场布局 考场的电脑。在所提出的仿真研究中，可以演示改进的系统设计 通过测量效率、准确性、工作量、以患者为中心、屏幕共享时间、 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，在模拟环境中重新设计布局。 为了实现目标2，我们建议根据现场诊所的实际患者访问情况进行试点实施。我们 将收集以患者为中心、屏幕共享、工作流程集成和情况感知的衡量标准 在重新设计的考场和当前的考场中了解重新设计的影响 检查室布局。现场临床研究的目的是收集更多的现场数据来支持 实验室模拟研究的结果，并最终有信心我们的干预 更大规模的研究，将支持在VHA范围内广泛传播重新设计的检查室布局。 通过这些目标，我们将完善和最终确定VHA的新考场设计，其基础是 社会技术系统视角。我们预计这项研究产生的知识将是可推广的 跨不同的医疗保健组织，在检查室方面增强以患者为中心 计算。

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.