A Study of an EHR to Translate Public Health Practices

描述（由申请人提供）： 充分的证据表明，公共卫生要素，如预防保健提醒，质量测量，免疫登记，病人教育材料提供公共卫生价值，但传播是穷人。电子健康记录（EHR）可能提供了一个解决方案，但EHR采用率低和公共卫生要素纳入EHR的情况不佳限制了其广泛使用。纽约市政府正在开展一项独特的项目，以改善城市的健康，投资超过2700万美元，以实施公共卫生启用电子健康记录（PHEEHR）的供应商谁治疗欠发达的病人在整个城市。我们的项目是研究这个PHEEHR纽约市的实施与发现的战略，可以提高PHEEHR采用和影响的目标。具体目标是：（1）通过在实践环境中检查有助于PHEEHR的采用和影响的背景因素来研究实施过程;（2）研究公共卫生要素和环境任务要素之间的复杂关系如何促进或阻碍PHEEHR的采用和影响;以及（3）根据目标1和2的结果制定和传播可推广的结论。我们将使用DeLone和姆克林信息系统模型来评估从PHEEHR系统本身开始开始的因果路径，并将用户满意度，采用率和影响纳入其中。这项研究的影响是多方面的，部分衡量标准是根据2010年健康人群和美国预防服务工作组指南提供预防服务和公共卫生报告的提供者网站的比例增加。DeLone和姆克林模型和一个任务-技术匹配结构的扩展模型将用从327个实践环境中收集的定量、定性和相关数据进行实证检验。将使用多水平结构方程模型（ML-SEM）评价两种模型。为了最大限度地提高我们研究结果的普遍性，我们将坚持从RE-AIM框架专门设计的标准化多维报告指标，以提高研究结果的可翻译性。我们的目标是扩展我们从这一前所未有的纽约市PHHEHR实施研究中所学到的东西，以告知其他可能在未来从事类似PHEEHR实施的人。

DESCRIPTION (provided by applicant): Ample evidence demonstrates that public health elements such as preventive care reminders, quality measurement, immunization registries, and patient education materials provide public health value, yet dissemination is poor. Electronic health records (EHRs) may provide a solution, but poor EHR adoption and poor incorporation of public health elements into EHRs limit their broad use. The New York City government is carrying out a unique project to improve the health of the city, investing over $27 million to implement a public health enabled EHR (PHEEHR) to providers who treat underserved patients throughout the city. Our project is to study this PHEEHR New York City implementation with the goal of discovering strategies that can enhance PHEEHR adoption and impact. Specific aims are 1) to study the implementation process by examining across practice settings the contextual factors that contribute to the adoption and impact of the PHEEHR; 2) to study how the complex relationships between public health elements and environmental task elements facilitate or hamper adoption and impact of the PHEEHR and 3) to develop and disseminate generalizable conclusions based on the results of aims 1 and 2. We will use the DeLone and McLean Information System Model to evaluate the causal paths that begin with the PHEEHR system itself, and incorporate user satisfaction, adoption, and impact. Impact in this study is multifaceted measured in part by an increase in the proportion of provider sites that perform preventative services and public health reporting based on Healthy People 2010 and the U.S. Preventive Services Task Force guidelines. The DeLone and McLean model and an extended model with a task-technology fit construct will be empirically tested with quantitative qualitative and relational data collected from 327 practice settings. Multilevel structural equation modeling (ML-SEM) will be used to evaluate both models. To maximize the generalizability of our findings, we will adhere to standardized multidimensional reporting metrics from the RE-AIM framework specifically designed to improve the translatability of research findings. Our goal is to extend what we learn from this unprecedented New York City PHHEHR implementation research study to inform others that are likely to engage in similar PHEEHR implementations in the future.