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科学家提供知识管理（KM）和临床决策支持（CDS）方面的重要专业知识，并在卫生服务研究中进行培训和指导。该提案旨在帮助申请人做好准备，以从事独立调查员的职业，开发和评估KM和CDS干预措施，旨在提高美国和国外医疗保健的质量，安全性，效率和有效性。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。学位和博士学位在生物医学信息学中。候选人是全公司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。候选人将由杜克临床研究所心血管研究主任Eric Peterson博士领导的一组既定研究人员指导。培训和研究将利用杜克大学独特的科学和培训资源。作为他的职业发展活动的主要组成部分，候选人将追求一个指导研究项目，重点是开发，实施和评估一个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CDS相关的卫生信息技术标准方面的专业知识;并准备手稿和赠款申请。拟议的研究的目标是开发，实施和评估一个可扩展的和广泛部署的知识交付服务（“知识经纪人”）的原型，能够自动提供特定的上下文知识从在线资源到电子健康记录（EHR）和个人健康记录（PHR）系统通过“知识仪表板”。“这项研究将根据三个具体目标进行：（i）建立患者和提供者知识需求的知识库;（ii）设计，开发和评估实验室环境中可扩展，可广泛部署的知识交付服务的可用性;（iii）在真实世界的医疗家庭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要的未解决的问题，即在护理过程中提出并未满足的大部分知识需求，可能导致医疗错误并损害护理的安全性和质量。此外，拟议的软件组件与HL 7内的国际标准的开发保持一致，以支持将知识资源整合到EHR和PHR系统中。因此，如果成功，拟议的研究将提供一个原型，以提供有可能在全国范围内复制的具体知识。拟议的研究解决了一个重要的未解决的问题，即在护理过程中提出并未满足的大部分知识需求，可能导致医疗错误并损害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医疗保健决策和以患者为中心的护理。拟议的系统将结合一项新出现的关于整合在线知识资源和电子健康记录的国际标准加以开发。因此，拟议的研究将提供一个原型的方法来提供具体的知识，有可能在全国范围内复制，并在公共卫生的整体改善发挥重要作用。

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.