Impact of Meaningful Use on Clinical Workflow in Emergency Departments

描述（由申请人提供）：电子健康记录（EHRs）等健康信息技术的进步可以减轻临床医生的负担，潜在地提高医疗保健的质量、安全性和效率。美国复苏和再投资法案（ARRA）的经济和临床健康健康信息技术（HITECH）条款提供了财政激励，将支付与电子病历的“有意义使用”（MU）标准的发展联系起来，这些系统正变得越来越普遍，它们对用户的可接受性和在临床环境中的影响越来越重要。我们提出了一种基于证据的经验方法来研究临床工作流程的三个特定关键要素：信息寻找、团队互动和临床医生使用电子病历的决策。虽然我们的实验重点是在急诊科（EDs）使用电子病历，但结果应该推广到其他临床环境，在这些环境中，电子病历必须与临床工作流程相结合。临床医生使用电子病历的三个工作流程要素将使用一组五个临床质量和效率指标来评估，以响应第2阶段MU标准。我们利用一套方法来捕获、分析和描述电子病历的影响，以便为未来符合mu的实施策略提供信息。我们的方法包括环境观察、临床医生跟踪、日志文件分析和基于射频识别（RFID）传感器的跟踪。这种以过程为导向的研究在两家城市医院的两个成人急诊科进行，并得到护理结果评估的支持，将指导制定可更好地融入临床社会结构的通用设计准则

DESCRIPTION (provided by applicant): Advances in health information technology such as Electronic Health Records (EHRs) can reduce the burden of complexity on clinicians, potentially improving quality, safety, and efficiency of healthcare. With the financial incentives offered by the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA), which linked payments to the development of "Meaningful Use" (MU) criteria for EHRs, these systems are becoming more prevalent and their acceptability to users and impact in clinical contexts are of increased importance. We propose an evidence-based, empirical approach for investigating three specific critical elements of clinical workflow: information seeking, team interaction, and decision making in the context of clinicians' use of EHRs. Although we focus our experiments on the use of EHRs in emergency departments (EDs), the results should generalize to other clinical settings in which EHRs must be integrated with clinical workflow. Clinicians' use of EHRs in relation to the three workflow elements will be evaluated using a set of five clinical quality and efficiency metrics during the implementation of features in response to Stage 2 MU criteria. We utilize a set of methodologies to capture, analyze and characterize the impact of EHRs so as to inform future MU-compliant implementation strategies. Our methods include environmental observations, clinician shadowing, log-file analysis, and radio frequency identification (RFID) sensor-based tracking. Such process-oriented studies, conducted in two adult emergency departments at two urban hospitals, supported by the evaluation of care outcomes, will guide the development of generalizable design guidelines that are better integrated within the social fabric of the clinical environment. We seek results that will contribute to the development of patient-safety and quality guidelines for EHR improvement, which will be suitable for incorporation into future MU stages. These results will also provide the Office of the National Coordinator (ONC) and the Centers for Medicare & Medicaid Services (CMS) with evidence to guide the evolving certification criteria for EHR vendors, and future regulations promoting meaningful use of EHRs.