Understanding Primary Care Teamwork in Context: Implications for HIT design

描述（由申请人提供）：美国复苏和再投资法案（ARRA）对临床医生有深远的影响-他们预计将采用和积极利用电子健康记录（EHR），或受到经济处罚。然而，在ARRA签署一个月后，国家研究理事会（NRC）得出结论，ARRA要求的EHR的全国部署可能会推迟21世纪的医疗保健目标。NRC报告的“中心结论”是，目前的EHR没有为医疗保健临床医生提供认知支持。此外，如果不支持临床医生的认知工作， 结果受到影响。对EHR的最新研究表明，采用率缓慢但不断增加，护理质量和安全性改善的结果好坏参半，护理成本没有降低，医生对EHR的使用不满意。我们建议，相关的问题失败的EHR的成就可以克服设计EHR支持临床医生的认知工作。这一前提与2009年NRC报告和2009年10月AHRQ资助的两份报告的结论一致，这两份报告呼吁AHRQ资助临床医生认知工作与EHR之间关系的研究。这个应用程序接受了这一挑战。我们的长期目标是开发新的EHR接口（数据显示和输入要求），可由供应商和/或信息技术程序员实施，并证明可支持和扩展临床医生和团队的认知工作，以改善患者的治疗效果。这个应用程序迈出了我们实现长期目标的第一步。我们的具体目标是（1）确定初级保健临床医生及其临床团队的认知工作要求，以及（2）开发和测试支持这些认知工作要求的特定EHR接口设计要求。我们选择把我们的研究重点放在初级保健，因为它的高利用率，高复杂性，以及目前的国家努力重新设计它以下的以病人为中心的医疗家庭模式。由于初级保健的认知复杂性，我们将采用旨在研究认知复杂工作的方法：认知任务分析（CTA）。CTA方法已经得到了很好的发展，并已被用于确定认知工作的要求，并开发信息技术，以支持其他复杂领域，如航空，核电，美国宇航局-最近-医疗保健的认知工作。使用一种称为目标导向任务分析的特定CTA方法，我们将临床医生和临床医生团队的认知需求映射到EHR界面设计。我们经验丰富的研究团队由人因工程、健康信息技术和初级保健领域的专家组成，拥有11年的合作历史，在完成这一重要奋进方面具有独特的优势。该应用程序建立在我们团队最近三次AHRQ资助的初级保健患者安全研究的成功基础上，并继续我们与威斯康星州基于实践的研究网络的富有成效的合作伙伴关系，以招募诊所和临床医生。

DESCRIPTION (provided by applicant): The American Recovery and Reinvestment Act (ARRA) has profound implications for clinicians - they are expected to adopt and actively utilize electronic health records (EHRs), or be subject to financial penalties. One month after ARRA was signed, however, the National Research Council (NRC) concluded that the nationwide deployment of EHRs called for by ARRA might set back 21st century healthcare goals. The "central conclusion" of the NRC report was that current EHRs do not provide cognitive support for health care clinicians. Further, if clinician cognitive work is not supported, patient care and outcomes suffer. The latest research on EHRs suggests slow but increasing adoption rates, mixed results regarding quality of care and safety improvement, no reduction in costs of care, and physician dissatisfaction with EHR use. We propose that issues related to failed EHR achievement can be overcome by designing EHRs which support the cognitive work of clinicians. This premise is consistent with conclusions from the 2009 NRC report and two October 2009 AHRQ-funded reports calling for AHRQ to fund research on the relationships between clinician cognitive work and EHRs. This application takes up that challenge. Our long-term goal is to develop new EHR interfaces (data displays and input requirements), implementable by vendors and/or information technology programmers, that are demonstrated to support and extend clinician and team cognitive work to improve patient outcomes. This application takes the first step toward our long-term goal. Our Specific Aims are to (1) identify the cognitive work requirements of primary care clinicians and their clinical teams, and (2) develop and test specific EHR interface design requirements that support these cognitive work requirements. We choose to focus our research on primary care because of its high utilization, high complexity, and the current national efforts to redesign it following the patient-centered medical home model. Due to the cognitive complexity of primary care, we will employ a method designed to study cognitively complex work: cognitive task analysis (CTA). CTA methods are well-developed, and have been used to determine cognitive work requirements and develop information technologies that support this cognitive work in other complex domains such as aviation, nuclear power, NASA - and recently - healthcare. Using a specific CTA method called Goal-Directed Task Analysis, we will map the cognitive requirements of clinicians and clinician teams to EHR interface design. Our experienced research team comprised of experts in human factors engineering, health information technology, and primary care, has an 11-year history of collaboration and is uniquely positioned to complete this important endeavor. This application builds on the successes of our team's three recent AHRQ-funded primary care patient safety studies, and continues our productive partnership with Wisconsin's Practice-Based Research Network, to recruit clinics and clinicians.