Developing Design Principles to Integrate PROs into clinical practice through HIT: Data, user experience, and workflow requirements for PRO Dashboards

 描述(由申请人提供)：将患者报告的结果(PRO)纳入临床评估和决策中，可改善患者与提供者的沟通、患者满意度和治疗监控。尽管PRO数据开始包括在健康信息技术(HIT)平台中，但大多数医疗保健提供者几乎没有使用PRO显示器或将PRO数据整合到医疗保健活动中的经验。作为医疗研究机构和质量赞助的华盛顿州比较有效性研究翻译网络(SERSY)的一部分，我们于2012年开始与华盛顿州各地诊所的医疗保健提供者共享PRO数据。我们开发了一个基于Web的PRO原型平台(实践中的PRO)，用于收集并向医疗团队展示PRO。专注于通过仪表板展示专业人士，我们招募了医生、护士和医疗团队的其他成员来提供关于平台形式和功能的反馈。这项试点工作揭示了关于这些用户将专业人员整合到他们的实践中的需求的证据上的巨大差距。我们发现，简单地将专业指标添加到结构化医疗记录中会导致意想不到的后果。医疗从业者和工作人员对使用PRO仪表板对临床工作流程的负面影响、需要根据不同类型的医疗团队成员的需求量身定做视觉显示以及与缺失数据和有效性相关的不确定性表示担忧。为了更有效地将PRO整合到临床护理中，需要开发一套与PRO的工作流程、用户体验和有效性/可解释性相关的循证设计原则。为了解决这一差距，我们计划在某些临床地点开展工作，并采用系统工程方法、以人为中心的设计和混合研究方法来开发设计原则，最终通过HIT将PRO数据更有效地集成到患者护理活动中。我们提出了三个目标：(1)评估关于PRO数据的集成和可解释性的信息需求和医疗决策过程；(2)通过以人为中心的方法指定医疗从业者对交互式PRO可视化的用户需求；以及(3)表征与通过HIT平台将PRO整合到临床护理活动中相关的临床工作流程需求和影响。人们对将PRO数据纳入临床护理有广泛的兴趣，但如何在不产生负面影响的情况下最有效地利用这些数据仍然是重要的问题。拟议的研究解决了HIT与PRO相关的基本问题，并将为与工作流程、最佳用户体验以及数据理解和解释相关的设计原则提供信息。由于它们是在一个不同的全州网络中开发的，这些设计原则很可能与全国各地正在或即将致力于将专业人员有效整合到临床护理中的其他人相关。

 DESCRIPTION (provided by applicant): Incorporating Patient-Reported Outcomes (PROs) into clinical assessments and decision making improves patient-provider communication, patient satisfaction, and treatment monitoring. Although PRO data is starting to be included in health information technology (HIT) platforms, most healthcare providers have little experience using PRO displays or incorporating PRO data into health care activities. As part of the Agency for Healthcare Research and Quality-sponsored Washington State Comparative Effectiveness Research Translation Network (CERTAIN), we began a process of sharing PRO data with healthcare providers in clinics across Washington State in 2012. We developed a prototype web-based PRO platform (PROs in Practice) for collecting and presenting PROs to healthcare teams. Focusing on the presentation of PROs through a dashboard, we recruited physicians, nurses, and other members of healthcare teams to provide feedback about the platform's form and function. This pilot work uncovered large gaps in evidence about the needs of those users for integrating PROs into their practice. We found that simply adding PRO metrics to structured medical records led to unintended consequences. Healthcare practitioners and staff raised concerns about the negative impact of using PRO dashboards on clinic workflow, the need to tailor visual displays to the needs of different types of healthcare team members, and uncertainties related to missing data and validity. To more effectively integrate PROs into clinical care, a set of evidence-based design principles related to workflow, user-experience, and validity/interpretability specific to PROs needs to be developed. To address this gap we plan to work across CERTAIN's clinical sites and employ systems engineering methods, human-centered design, and mixed-research methods to develop design principles that will ultimately enable more effective integration of PRO data into patient care activities through HIT. We propose three aims: (1) Evaluate the information needs and healthcare decision making processes regarding the integration and interpretability of PRO data; (2) Specify healthcare practitioner user requirements for interactive PRO visualizations through human-centered methods; and (3) Characterize clinical workflow needs and impact associated with integration of PROs into clinical care activities through HIT platforms. There is broad interest in incorporating PRO data into clinical care, but important questions remain about how these data can be most effectively used without a negative impact. The proposed studies address fundamental issues for HIT related to PROs and will inform design principles related to workflow, optimal user experience, and data comprehension and interpretation. Since they are being developed in a diverse statewide network, these design principles are likely to be relevant to others across the nation who are, or will soon be, working on effective integration of PROs into clinical care.