Immersive Simulation for Design and Evaluation of an Emergency Department IT

描述（由申请人提供）：在各种医疗保健环境中，包括急诊科（ED），健康信息系统的实施有着强大而快速的推动力。卫生保健信息系统被提倡作为各种问题的解决方案，包括成本，效率，病人安全和医疗差错。然而，关键的挑战是创造信息技术解决方案，实际提供所承诺的好处。新技术的设计往往对它们需要支持的工作和将使用系统的人只有有限的了解，或者设计的重点是管理功能，而不是病人护理功能。许多其他复杂的安全关键领域的研究人员已经记录了可以追溯到新信息技术设计的危险和困难。如果不仔细了解新技术在实践中的使用方式，或者不按预期使用新技术的障碍，新技术可能会导致意想不到的不良后果。这些可能包括由于新流程或变通方法而增加的工作量，或者如果系统被绕过或放弃，或者关键任务中断，则会导致严重的安全隐患。正在开发的用于提高艾德环境中的效率和安全性的一种技术形式是计算机化患者跟踪。这些系统旨在取代通常用于管理艾德工作的手动状态板。状态板（通常是大型白板）包含有关患者的医疗和后勤信息，并为临床和支持人员提供有关患者的信息以及有关医院状态和团队协调信息的更高级别信息。当前实现的状态板的电子版本可以模仿手动板的外观和布局，允许在医院的不同位置访问状态板上的信息，并提供自动记录保持和报告。然而，研究表明，它们也对使用施加了新的限制，错过了最好地支持医疗保健提供者工作的机会，并引入了新的错误来源和意外后果。本研究提出利用模拟和认知系统工程方法来设计和测试原型艾德信息系统，该系统基于对ED内护理人员和工作人员的任务和活动的深入理解。将使用多阶段策略，其中艾德活动的关键方面将被建模，原型将被迭代开发，原型将在临床模拟中心环境中进行评估。研究结果将影响急诊科，因为他们实施电子艾德信息系统，确保这些系统实际上提高效率和安全性，减少艾德等待时间，并减少不必要的医源性损伤的病人在整个美国。 公共卫生相关性：“急诊科IT系统的设计和评估的沉浸式模拟”项目说明本项目将人的因素和认知系统工程学应用于医疗保健（具体而言，急诊科业务）的信息技术系统的设计，因此与公共卫生相关。认知系统工程是一个已被用于航空和核电等其他复杂行业的领域，以提高安全性和操作性能，并有可能在医疗保健领域做同样的事情。

DESCRIPTION (provided by applicant): There is a strong and rapid push towards the implementation of health information systems in a variety of health care contexts, including emergency departments (EDs). Health care information systems are advocated as solutions to a variety of problems including cost, efficiency, patient safety, and medical errors. However, the critical challenge is in creating information technology solutions that actually deliver the benefits that are promised. New technologies are often designed with only a limited understanding of the work they need to support and the people who will use the systems, or are designed with a focus on administrative functions rather than patient care functions. Researchers in numerous other complex, safety critical domains have documented hazards and difficulties that can be traced to the design of new information technology. Without a careful understanding of how new technologies will be used in practice, or the barriers to their use as expected, new technology can lead to unanticipated, undesirable consequences. These may include increased workload due to new processes or work-arounds, or serious safety compromises if systems are bypassed or abandoned, or critical tasks interrupted. One form of technology that is being developed to improve efficiency and safety in ED settings is computerized patient tracking. These systems are intended to replace manual status boards that are commonly used for managing ED work. Status boards (typically, large whiteboards) contain medical and logistical information about patients and provide clinical and support staff with information about patients as well as higher level information regarding hospital state and team coordination information. Currently implemented electronic versions of the status boards may mimic the look and layout of manual boards, allow information on the status board to be accessed at different locations in the hospital and provide automated recording keeping and reporting. However, research shows that they also impose new constraints on use, miss the opportunity to best support the work of the healthcare providers, and introduce new sources of error and unanticipated consequences. This research proposes to utilize simulation and cognitive systems engineering methods to design and test prototype ED information systems which are based on an in depth understanding of the task and activities of caregivers and staff within the ED. A multi-phase strategy will be used in which key aspects of ED activities will be modeled, prototypes will be iteratively developed, and prototypes will be assessed in an clinical simulation center environment. The research outcomes will impact EDs as they implement electronic ED information systems, insuring that these systems actually do improve efficiency and safety, decrease ED wait times, and decrease unnecessary iatrogenic injuries to patients throughout the US. PUBLIC HEALTH RELEVANCE: "Immersive Simulation for Design and Evaluation of an Emergency Department IT System" Project Narrative This project is relevant to public health because it applies the science of human factors and cognitive systems engineering to the design of information technology systems for health care (specifically, emergency department operations). Cognitive systems engineering is a field which has been used in other complex industries such as aviation and nuclear power to improve safety and operating performance, and has the potential to do the same in healthcare.