Patient-Centered Informatics System to Enhance Health Care in Rural Communities

描述（由申请人提供）：我们提出一个研究示范项目，以评估整合电子病历、个人健康档案和通信系统的功能是否能在山间西部的农村社区带来更多以患者为中心的医疗服务。该系统被我们称为统一健康资源（UHR），它将患者控制的个人健康记录与读取电子病历信息的能力结合起来，并在必要时提高电子病历信息的准确性。控制电子医疗记录中的信息的临床医生在获得患者的访问权限后，可以查看个人健康记录并对其进行评论。结构化电子访问支持临床医生、临床工作人员和患者之间的几种类型的电子通信。诊所向患者发送各种自动提醒，包括结构化的电子表格，以要求电子报告药物不良事件的可能症状，并促进在亲自就诊之前更好地组织关注问题。患者要求补充药物，并在线报告家庭监测测试结果，如血压读数和血糖值。该系统促进了临床医生和患者药物清单的核对。该建议以我们以前在农村环境中实施和评估卫生信息技术的工作为基础。参与我们之前研究的诊所将被招募到这个新项目中。我们将应用形成性评估方法来评估和改进可用性、有用性和采用率。为了评估对以患者为中心的护理的影响，患者将被招募到一个多社区观察队列研究中。患者激活、参与决策、自我管理行为、用药管理和预防措施将在基线和随访期间陆续获得。在第三年，我们会在社区范围内展开教育运动，提高市民对个人健康纪录的认识，以及利用与临床医生的非同步沟通，以促进市民采纳《全民健康档案》。总而言之，UHR结合了多种电子工具的功能，使患者能够更好地控制自己的健康数据，增加解决个人健康问题的选择，并改善临床护理的可及性和连续性，不受时间和地点的限制。这种卫生信息技术将支持临床医生和患者之间互动的新模式，旨在增加以患者为中心的护理。我们在农村公共卫生框架内开展了一项教育运动，这将有助于使得不到充分服务的人口受益，并指导全国范围内的宣传工作。

DESCRIPTION (provided by applicant): We propose a research demonstration project to evaluate whether integrating the functions of an electronic medical record, personal health record, and communication system leads to more patient-centered care in rural communities in the Intermountain West. This system, which we call the Unified Health Resource (UHR), combines the patient controlled personal health record with the ability to read and, if necessary, improve the accuracy of the information in the electronic medical record. The clinician, who controls information in the electronic medical record, can view and comment on the personal health record, when granted access by the patient. Structured e-visits support several types of electronic communications between clinicians, clinic staff, and patients. Clinics send a variety of automated reminders to patients, including structured electronic forms to solicit electronic reporting of possible symptoms of adverse drug events and to promote better organization of concerns prior to in-person visits. Patients request medication refills and report results of home monitoring tests, such as blood pressure readings and blood glucose values online. The system facilitates the reconciliation of clinician and patient medication lists. The proposal builds on our prior work to implement and evaluate health information technology in rural settings. Clinics that participated in our previous studies will be recruited to this new project. We will apply formative evaluation methods to assess and improve usability, usefulness, and adoption. To estimate impact on patient-centered care, patients will be recruited to a multi-community observational cohort study. Measures of patient activation, involvement in decision-making, self-management behaviors, medication management, and preventive practices will be obtained at baseline and serially during follow-up. During Year Three, we will launch a community-wide education campaign to enhance adoption of the UHR by increasing awareness of personal health records and the utility of asynchronous communication with clinicians. In summary, the UHR combines the functions of multiple electronic tools to bring patients enhanced control of their own health data, increased options for solving personal health issues, and improved access and continuity of clinical care, freed from constraints of time and location. This health information technology will support a new model of interaction between clinicians and patients, aiming to increase the patient-centeredness of care. Our implementation of an education campaign within a rural public health framework will help extend the benefits to underserved populations and to guide nationwide dissemination efforts.