Context-Aware Knowledge Delivery into Electronic Health Records

描述(由申请人提供)：这个为期四年的项目旨在为临床医生和科学家提供卫生服务研究方面的培训和指导，使其具备知识管理(KM)和临床决策支持(CDS)方面的重要专业知识。该提案旨在使申请人做好准备，成为一名独立的调查员，开发和评估旨在提高美国和国外医疗保健质量、安全、效率和有效性的知识管理和疾病预防干预措施。该候选人是杜克大学临床信息学助理教授，拥有医学博士学位和生物医学信息学博士学位。候选人是企业范围的临床知识交付基础设施的架构师，也是国际知识交付标准的作者。候选人将由以杜克临床研究所心血管研究主任埃里克·彼得森博士为首的一组成熟的研究人员进行指导。培训和研究将利用杜克大学独特的科学和培训资源。作为其职业发展活动的主要组成部分，候选人将进行一个有指导的研究项目，重点是开发、实施和评估可扩展和可复制的知识交付系统的原型。候选人还将接受正式培训，特别是在卫生服务研究方面；发展与知识管理和疾病预防和预防相关的卫生信息技术标准方面的专门知识；并准备手稿和拨款申请。拟议研究的目标是开发、实现和评估一个可扩展且可广泛部署的知识交付服务(“知识中介”)的原型，该服务能够通过“知识仪表板”自动将特定于上下文的知识从在线资源传递到电子健康记录(EHR)和个人健康记录(PHR)系统中。研究将按照三个具体目标进行：(I)建立患者和提供者知识需求的知识库；(Ii)在实验室环境中设计、开发和评估可扩展、可广泛部署的知识交付服务的可用性；(Iii)在现实世界的医疗之家环境中对知识经纪人的试点实施进行混合方法评估。拟议的研究解决了一个重大的悬而未决的问题，即在护理过程中提出并未满足的大部分知识需求，可能会导致医疗差错，并危及护理的安全性和质量。此外，拟议的软件构成部分与HL7内制定的国际标准保持一致，以支持将知识资源整合到EHR和PHR系统中。因此，如果成功，拟议的研究将为提供特定背景知识的方法提供一个原型，这些知识有可能在全国范围内复制。拟议的研究解决了一个重大的悬而未决的问题，即在护理过程中提出并未满足的大部分知识需求，可能会导致医疗差错，并危及护理的安全性和质量。该项目旨在通过向患者和提供者提供相关的特定背景知识来支持卫生保健决策和以患者为中心的护理。拟议的系统将与关于在线知识资源和电子健康记录之间的整合的新的国际标准一起开发。因此，拟议的研究将为提供针对具体情况的知识的方法提供一个原型，这些知识有可能在全国范围内复制，并在全面改善公共卫生方面发挥重要作用。

DESCRIPTION (provided by the applicant): This four-year project seeks to equip a clinician-scientist with a significant expertise in knowledge management (KM) and clinical decision support (CDS) with training and mentoring in health services research. This proposal aims at preparing the applicant to pursue a career as an independent investigator developing and evaluating KM and CDS interventions aimed at improving the quality, safety, efficiency, and effectiveness of health care in the U.S. and abroad. The candidate is an Assistant Professor of clinical informatics at Duke University with an M.D. degree and a Ph.D. in biomedical informatics. The candidate is the architect of a corporate-wide clinical knowledge delivery infrastructure and the author of an international knowledge delivery standard. The candidate will be mentored by a group of established investigators headed by Dr. Eric Peterson, the Director of Cardiovascular Research at the Duke Clinical Research Institute. The training and research will leverage unique scientific and training resources available at Duke University. As the primary component of his career development activities, the candidate will pursue a mentored research project focused on the development, implementation, and evaluation of a prototype for a scalable and replicable knowledge delivery system. The candidate will also pursue formal training, particularly in health services research; develop expertise in health IT standards relevant to KM and CDS; and prepare manuscripts and grant applications. The goal of the proposed research is to develop, implement, and evaluate a prototype for a scalable and widely deployable knowledge delivery service ("knowledge broker") capable of automatically delivering context-specific knowledge from online resources into electronic health record (EHR) and personal health record (PHR) systems via a "knowledge dashboard." The research will be conducted in accordance with three specific aims: (i) to build a knowledge base of patients' and providers' knowledge needs; (ii) to design, develop, and evaluate the usability of a scalable, widely deployable knowledge delivery service in a laboratory setting; (iii) To conduct a mixed-method assessment of a pilot implementation of the knowledge broker in a real-world Medical Home environment. The proposed research addresses a significant unsolved problem related to the large percentage of knowledge needs that are raised and not met during the course of care, potentially leading to medical errors and compromising the safety and quality of care. In addition, the proposed software component is aligned with the development of an international standard within HL7 to support the integration between knowledge resources into EHR and PHR systems. Thus, if successful, the proposed research will provide a prototype for an approach to delivering context-specific knowledge that could potentially be replicated on a national scale. The proposed research addresses a significant unsolved problem related to the large percentage of knowledge needs that are raised and not met during the course of care, potentially leading to medical errors and compromising the safety and quality of care. This project seeks to support health care decision making and patient-centered care by delivering relevant, context-specific knowledge to patients and providers. The proposed system will be developed in conjunction with an emerging international standard on the integration between online knowledge resources and electronic health records. Thus, the proposed research will provide a prototype for an approach to delivering context-specific knowledge that could potentially be replicated on a national scale and play a significant role in the overall improvement of public health.