Immersive Simulation for Design and Evaluation of an Emergency Department IT

描述（由申请人提供）：在包括急诊科在内的各种卫生保健环境中，卫生信息系统的实施受到了强劲而迅速的推动。医疗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、患者安全和医疗错误。然而，关键的挑战在于创建能够实际提供所承诺的好处的信息技术解决方案。在设计新技术时，通常只对它们需要支持的工作和使用这些系统的人员有有限的了解，或者在设计时侧重于管理功能而不是患者护理功能。在许多其他复杂、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将如何在实践中使用，或者按照预期使用它们的障碍，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，则会严重危及安全。为了提高急诊科的效率和安全性，正在开发的一种技术是计算机化的病人跟踪。这些系统旨在取代通常用于管理ED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，并向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高级信息。目前实施的电子状态板可能模仿手动状态板的外观和布局，允许在医院的不同位置访问状态板上的信息，并提供自动记录保存和报告。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想不到的后果。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ED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了解。将采用多阶段策略，其中ED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在实施电子急诊科信息系统时，确保这些系统确实提高了效率和安全性，减少了急诊科的等待时间，并减少了全美患者不必要的医源性伤害。

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.