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，以评估整合电子病历、个人健康记录和通信系统的功能是否会在西部山区农村社区带来更多以患者为中心的护理。这个系统，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读取能力相结合，并在必要时提高电子病历中信息的准确性。当患者允许访问时，控制电子病历中的信息的临床医生可以查看和评论个人健康记录。结构化电子访问支持临床医生、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，包括结构化电子表格，以要求以电子方式报告不良药物事件的可能症状，并促进在面对面就诊之前更好地组织关注事项。患者要求补充药物，并在网上报告家庭监测测试的结果，如血压读数和血糖值。该系统有助于调节临床医生和患者的用药列表。该提案建立在我们在农村环境中实施和评估卫生信息技术的先前工作的基础上。参与我们先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改进可用性、有用性和采用率。为了评估对以患者为中心的护理的影响，患者将被招募到一个多社区观察性队列研究中。患者活跃度、参与决策、自我管理行为、用药管理和预防措施的测量将在基线和后续期间获得。在第三年，我们会在全社会推行一项教育运动，透过提高市民对个人健康纪录的认识，以及加强与临床医生之间的非同步通讯，以加强市民对《医疗卫生条例》的认识。总而言之，UHR结合了多种电子工具的功能，为患者带来了对自己健康数据的增强控制，增加了解决个人健康问题的选择，并改善了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一种新的临床医生和患者之间的互动模式，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实施的教育运动将有助于将受益扩大到服务不足的人群，并指导全国的传播工作。

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.