Data Flow & Clinical Outcomes in a Perinatal Continuum of Care System

描述(由申请人提供)：卫生信息技术(HIT)现在处于卫生保健改善议程的前沿，因为它有潜力实现改善临床结果和效率所必需的减少医疗差错和增加患者安全。我们正在研究利哈伊谷卫生网络在其妇产科实践小组和该网络主要医院的分娩和分娩(L&D)股实施一种特定的HIT应用程序--综合电子病历系统。在这个过程中，每个实践小组都将迁移到一个供应商提供的单一EMR，这些EMR将连接到医院L诊疗部新升级的系统，形成一个集成的EMR。一旦安装了该系统，当患者到达L医院时，将立即获得来自每个医生办公室的医疗信息，患者到L医院就诊的信息将发送回该办公室。我们的目标是使用定性和定量方法来评估这一系统的影响，以便我们能够全面评估综合EMR的能力，以解决公认的未能在围产期连续护理的关键临床点向医生和临床工作人员提供准确、完整和及时的数据的问题。我们有四个具体的目标：目标1：通过对技术接受和使用的定性分析，以及补充的组织和流程变化，开发扎根理论来描述供应商提供的门诊电子病历系统与医院信息系统的有效实施和集成的过程。目标2：定量检查采用综合电子病历系统后医院和个人的数据完整性(完整和可访问的数据)方面的变化。目标3：定量检查健康结果的改善、工作人员对患者安全的感知、患者和医务人员的满意度，以及初级保健和住院医生生产力的变化。目的4：使用混合方法，对定量和定性分析的结果进行三角划分，以更深入地了解如何从综合电子病历中获得好处。

DESCRIPTION (provided by applicant): Health information technology (HIT) is now at the forefront of the health care improvement agenda because of its potential to achieve the reductions in medical errors and increases in patient safety necessary to improve clinical outcomes and efficiency. We are studying the implementation by the Lehigh Valley Health Network (LVHN) of a particular HIT application, an integrated electronic medical record (EMR) system, at its OB/GYN practice groups and the Labor and Delivery (L&D) Unit at the network's main hospital. In this process, each of the practice groups is migrating to a single, vendor-supplied, EMR, and these EMRs will be linked to a newly-upgraded system at the hospital's L&D Unit to form an integrated EMR. Once the system is installed, medical information from each physician office will be immediately available when a patient arrives at L&D, and information from a patient's visits to L&D will sent back to the office. Our goal is to use both qualitative and quantitative methods to evaluate the impact of this system, so that we can fully assess the ability of an integrated EMR to address a recognized failure to deliver accurate, complete, and timely data to physicians and clinical staff at critical clinical points along the perinatal continuum of care. We have four specific aims: Aim 1: Develop grounded theory to describe the process of effective implementation and integration of vendor-supplied ambulatory EMR systems with hospital information systems through qualitative analysis of technology acceptance and use, and complementary organizational and process changes. Aim 2: Examine quantitatively the change in data completeness (complete and accessible data) at the hospital and at the individual practices resulting from the adoption of the integrated EMR system. Aim 3: Examine quantitatively improvements in health outcomes, staff perceptions of patient safety, and patient and medical staff satisfaction, as well as changes in the productivity of primary care and inpatient physicians. Aim 4: Using mixed methods, triangulate the results of the quantitative and qualitative analyses to gain a deeper understanding of how to achieve benefits from an integrated EMR.