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，临床实践模式存在很大差异，医疗费用的上升在很大程度上有增无减。信息技术在医疗保健中的基本价值主张受到越来越多的审查，同时越来越多的人认为，信息技术的有效应用对改善患者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，以及通过提供关于EHR质量和基准的医生绩效反馈，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以及患者安全和质量目标展示价值，并通过创新的EHR技术解决临床工作流程支持和决策支持的综合需求。我们假设，两个EHR为基础的干预措施：第一个侧重于一个基于表格的，临床文档为中心的，决策支持的方法的影响，第二个提供临床医生的具体性能报告，在护理点的指导方针的遵守和质量基准的实现，将显着增加EHR的感知价值的最终用户临床医生。我们建议解决三个相关的研究问题，以阐明这一领域的调查：1）可以开发一个可用的EHR干预，提供临床决策支持的背景下，临床文件的工作流程，并集成了基于人口的性能反馈给医生; 2）这些工具是否改善了临床决策支持和质量评估的关键数据的捕获，符合最佳实践指南，和临床文件的质量，以及3）使用这些工具是否具有成本效益-在为急性呼吸道疾病（ARI）或冠状动脉疾病（CAD）患者提供护理的情况下，药物、测试和程序的使用是否有影响？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IT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，并且永远不会实现患者安全，质量和成本方面的次要收益。

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.