Patient-Centered Informatics System to Enhance Health Care in Rural Communities

描述（由申请人提供）：我们提出了一个研究示范项目，以评估是否整合电子病历，个人健康记录和通信系统的功能，导致更多的以病人为中心的护理在山区西部的农村社区。该系统，我们称之为统一健康资源（UHR），将患者控制的个人健康记录与阅读能力相结合，并在必要时提高电子医疗记录中信息的准确性。控制电子医疗记录中的信息的临床医生在被患者授予访问权限时可以查看和评论个人健康记录。结构化电子就诊支持临床医生、诊所工作人员和患者之间的几种类型的电子通信。诊所向患者发送各种自动提醒，包括结构化的电子表格，以征求对药物不良事件可能症状的电子报告，并促进在亲自访视之前更好地组织问题。患者要求药物补充和报告结果的家庭监测测试，如血压读数和血糖值在线。该系统有助于临床医生和患者药物列表的协调。该提案建立在我们先前在农村环境中实施和评估卫生信息技术的工作基础上。参与我们以前研究的诊所将被招募到这个新项目中。我们将应用形成性评估方法来评估和提高可用性，有用性和采用。为了估计对以患者为中心的治疗的影响，将招募患者参加多社区观察性队列研究。将在基线和随访期间连续获得患者激活、参与决策、自我管理行为、药物管理和预防措施的指标。在第三年，我们将发起一个全社会的教育运动，以提高通过提高个人健康记录和异步通信与临床医生的效用的认识，以提高采用UHR。总之，UHR结合了多种电子工具的功能，使患者能够更好地控制自己的健康数据，增加解决个人健康问题的选择，并改善临床护理的可及性和连续性，不受时间和地点的限制。这种健康信息技术将支持临床医生和患者之间互动的新模式，旨在提高以患者为中心的护理。我们在农村公共卫生框架内开展教育运动，将有助于使得不到充分服务的人口受益，并指导全国范围的宣传工作。

DESCRIPTION (provided by applicant): We propose a research demonstration project to evaluate whether integrating the functions of an electronic medical record, personal health record, and communication system leads to more patient-centered care in rural communities in the Intermountain West. This system, which we call the Unified Health Resource (UHR), combines the patient controlled personal health record with the ability to read and, if necessary, improve the accuracy of the information in the electronic medical record. The clinician, who controls information in the electronic medical record, can view and comment on the personal health record, when granted access by the patient. Structured e-visits support several types of electronic communications between clinicians, clinic staff, and patients. Clinics send a variety of automated reminders to patients, including structured electronic forms to solicit electronic reporting of possible symptoms of adverse drug events and to promote better organization of concerns prior to in-person visits. Patients request medication refills and report results of home monitoring tests, such as blood pressure readings and blood glucose values online. The system facilitates the reconciliation of clinician and patient medication lists. The proposal builds on our prior work to implement and evaluate health information technology in rural settings. Clinics that participated in our previous studies will be recruited to this new project. We will apply formative evaluation methods to assess and improve usability, usefulness, and adoption. To estimate impact on patient-centered care, patients will be recruited to a multi-community observational cohort study. Measures of patient activation, involvement in decision-making, self-management behaviors, medication management, and preventive practices will be obtained at baseline and serially during follow-up. During Year Three, we will launch a community-wide education campaign to enhance adoption of the UHR by increasing awareness of personal health records and the utility of asynchronous communication with clinicians. In summary, the UHR combines the functions of multiple electronic tools to bring patients enhanced control of their own health data, increased options for solving personal health issues, and improved access and continuity of clinical care, freed from constraints of time and location. This health information technology will support a new model of interaction between clinicians and patients, aiming to increase the patient-centeredness of care. Our implementation of an education campaign within a rural public health framework will help extend the benefits to underserved populations and to guide nationwide dissemination efforts.