Shared Online Health Records for Patient Safety and Care

描述（由申请人提供）：由于人口老龄化、慢性病患病率增加、越来越重视协作护理以及降低成本的巨大压力，门诊患者的医疗护理正在迅速变化。 为了支持从传统的偶发性护理范式向新的连续性护理范式的转变，医生和患者需要更好的工具来进行医患沟通，在诊所外进行患者导向的护理，以及协调患者和医疗专业人员的护理。 互联网的日益普及、电子邮件的广泛接受以及电子病历（EMR）的激增为患者和医生提供了新的机会，使他们能够在提高门诊护理质量和加强用药安全方面进行合作。 该应用程序将解决电子患者-提供者通信和共享在线健康记录工具对患者护理和安全性的影响。 将提出四个相关问题：1）通过患者提示和共享患者/医生EMR药物列表，药物安全性是否得到改善？ 2)患者提示、提醒和EMR条目是否改善了慢性病结局，以及对医疗保健维护和慢性病指南的依从性？3)提示患者家族史评估是否能提高家族危险因素的检测？ 4)电子通信和病人和医生共享电子病历对医疗实践有何影响？如何解决这些障碍？这些问题将通过一项随机前瞻性队列研究来解决，研究对象是使用安全、协作、基于Web的电子病历和通信系统共享健康信息的患者和医疗服务提供者。

DESCRIPTION (PROVIDED BY APPLICANT): Medical care of the outpatient is rapidly changing because of the aging population, increased prevalence of chronic disease, increased emphasis on collaborative care, and unrelenting pressure to reduce costs. To support the shift from the traditional episodic paradigm of care to the new continuous paradigm of care, physicians and patients need better tools for patient-doctor communication, patient-directed care outside of the clinic, and coordination of the care directed by patients and medical professionals. The increased availability of the Internet, wide acceptance of email, and proliferation of electronic medical records (EMRs) offer patients and physicians new opportunities to collaborate on improving the quality of outpatient care and enhancing medication safety. This application will address the impact on patient care and safety of tools for electronic patient-provider communication and shared online health records. Four related questions will be asked: 1) Is medication safety improved with patient prompts and a shared patient/physician EMR medication list? 2) Do patient prompts, reminders, and EMR entries improve chronic disease outcomes and adherence to guidelines in health care maintenance and chronic disease? 3) Does a prompted patient family history assessment improve detection of familial risk factors? 4) How does electronic communication and the shared use of the EMR by patients and physicians impact on medical practice, and how might barriers be addressed? These questions will be addressed by a randomized prospective cohort study of patients and providers who share health information using a secure, collaborative, Web-based electronic medical record and communication system.