Evaluating Smart Forms and Quality Dashboards in an EHR

描述(由申请人提供)：电子健康记录(EHR)已经成熟。现代临床实践要求临床医生注意最佳实践，并警惕过度利用和成本。然而，大量数据表明，最佳证据和实践之间存在差距，临床实践模式仍然存在巨大差异，医疗成本的上升基本上有增无减。信息技术在医疗保健中的基本价值主张已受到越来越多的审查，同时越来越多的人认识到，有效地应用信息技术对提高患者的安全和质量至关重要。该应用程序旨在通过创建与临床文档工作流程集成的临床决策支持工具，以及通过在EHR中提供关于质量和基准的医生表现反馈，更好地向最终用户临床医生展示IT的价值。我们的目标是向临床医生展示价值，以及患者安全和质量的目标，并利用创新的电子病历技术满足临床工作流程支持和决策支持的组合需求。我们假设，两种基于电子病历的干预措施：第一种侧重于以表格为基础、以临床文件为中心的决策支持方法的影响，第二种侧重于提供关于指南遵从性和护理点质量基准实现情况的临床医生特定绩效报告，将显著增加最终用户临床医生对电子病历的感知价值。我们建议解决三个相关的研究问题来阐明这一调查领域：1)能否开发出可用的EHR干预措施，在临床文件工作流程的背景下提供临床决策支持，并将基于人群的绩效反馈整合到医生；2)此类工具是否改进了临床决策支持和质量评估的关键数据的捕获、对最佳实践指南的遵从性以及临床文件的质量；3)此类工具的使用是否具有成本效益--在为急性呼吸道疾病(ARI)或冠心病(CAD)患者提供护理的背景下，药物、测试和程序的利用是否有影响？我们相信，这些都是基本的价值问题，对于在实践中广泛采用信息技术至关重要。如果最终用户没有意识到这些工具主要在临床工作流程中的价值，医疗保健IT将永远不会被采用，患者安全、质量和成本方面的次要收益也永远不会实现。

DESCRIPTION (provided by the applicant): Electronic health records (EHR) have come of age. Modern clinical practice requires a clinician to be mindful of best practices, and wary of excess utilization and cost. However, abundant data show that gaps exist between best evidence and practice, wide variations persist in clinical practice patterns, and escalation of healthcare costs continues largely unabated. The fundamental value proposition of IT in health care has come under increased scrutiny while it is increasingly accepted that the effective application of IT is critical for improved patient safety and quality. This application aims to better demonstrate the value of IT to the end-user clinician through creation of clinical decision support tools integrated with clinical documentation workflow, and through provision of physician performance feedback on quality and benchmarks in the EHR. We aim to demonstrate value to the clinician, as well as to the goals of patient safety and quality, and address the combined needs of clinical workflow support and decision support with innovative EHR technology. We hypothesize that two EHR-based interventions: the first focusing on the impact of a forms-based, clinical documentation-centric, approach to decision support, and the second on providing clinician specific performance reports regarding guideline compliance and quality benchmark achievement at the point of care, will significantly increase the perceived value of EHR to the end-user clinician. We propose to address three related research questions to illuminate this area of inquiry: 1) can a usable EHR intervention be developed which provides clinical decision support in the context of clinical documentation workflow, and which integrates population-based performance feedback to the physician; 2) do such tools improve the capture of key data for clinical decision support and quality assessment, compliance with best practice guidelines, and the quality of clinical documentation, and 3) is the use of such tools cost-effective - is there an impact utilization of medications, tests, and procedures in the setting of either care provided for patients with acute respiratory illness (ARI), or coronary artery disease (CAD)? We believe these are fundamental value questions which are critical to the broad adoption of IT in practice. If the end-user does not perceive the value of these tools primarily in the clinical workflow, healthcare IT will never be adopted, and secondary gains in patient safety, quality, and costs will never be achieved.