Shared Online Health Records for Patient Safety and Care

描述（由申请人提供）：由于人口老龄化、慢性病患病率上升、对协作护理的日益重视以及降低成本的持续压力，门诊医疗正在迅速发生变化。为了支持从传统的偶发式护理模式向新的连续式护理模式的转变，医生和患者需要更好的工具来进行医患沟通，在诊所之外进行患者指导的护理，并协调患者和医疗专业人员指导的护理。Internet可用性的提高、电子邮件的广泛接受以及电子医疗记录（emr）的普及为患者和医生提供了新的合作机会，以提高门诊护理的质量和增强药物安全性。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的影响。将提出四个相关问题：1)患者提示和共享的患者/医生电子病历用药清单是否改善了用药安全性？2)患者提示、提醒和EMR条目是否改善了慢性病的结局和对医疗保健维护和慢性病指南的依从性？3)提示性患者家族史评估是否能提高家族危险因素的发现？4)电子通信和患者和医生共同使用电子病历对医疗实践有何影响？如何解决障碍？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.