Open & Act: Tracking Healthcare Team Response to EHR Asynchronous Alerts

描述(由申请人提供)：基于电子健康记录(EHR)的异步消息传递是一种安全的电子邮件样式的消息交换形式，被医疗团队广泛使用，用于交流对时间敏感的患者信息，而无需发送者和接收者同时参与。异步警报是一种消息，其主要目标是促使医疗团队及时采取相关行动，以改善患者的预后。与在任务中途中断用户的警报不同，异步警报被发送到一个安全的电子“收件篮”，在那里它们等待打开。虽然许多研究描述了中断性警报，但对异步警报的使用、影响和风险知之甚少。这是一个重要的差距。通常，对于时间敏感的问题，异步警报是向医疗团队成员发出的唯一通知；未打开的警报代表潜在的危险通信中断。通过以前的AHRQ资助(R18 HS017203)，我们实施了警报干预，通知初级保健团队药物安全问题和住院后密切办公室随访的必要性。在1282名老年患者出院后，我们发送了自动的异步警报，但我们没有发现任何证据表明这对患者的预后有影响。初步审查显示，40%的工作人员指示的警报和19%的初级保健提供者警报在分娩后第一天结束时仍未打开。各种社会技术因素可能会影响警报的开启和随后的行动。我们汇编了丰富的数据集合，其中包含有关警报的详细信息、触发这些警报的放电、上下文因素(例如，在警报发送时收件人的“收件篮”中未打开的邮件数量)、患者和提供者特征以及临床结果数据。我们用电子跟踪数据(“数字碎屑”)丰富了这些数据，记录了创建和审查EHR数据元素的日期和时间。我们建议进行二次数据分析，以确定与(A)及时相关的背景因素、警报类型和提供者、患者和医院出院的特征 在收到警报后打开警报，以及(B)在收到警报并打开警报后及时采取第一反应行动。我们还将进行顺序模式分析，描述医疗保健提供者在警报打开后立即采取的相关行动。最后，我们将评估警报开放后及时的第一反应行动与关键患者结果(办公室就诊、再次住院、急诊室和外科护理就诊以及药物不良事件)之间的关系。我们的研究是及时和创新的，它提出了使用数字面包屑的建议，这是一个很大程度上尚未开发的数据源，将使我们能够识别警报-响应路径上的通信故障点。EPIC系统公司是我们收集数据的EHR系统，它存储了近1.27亿患者的医疗信息，占美国人口的近40%。我们的研究团队通过使用数字碎屑跟踪警报打开和响应所学到的内容将广泛适用于全国各地的医疗团队和研究人员，并将为未来异步警报系统的设计和实施提供参考。

DESCRIPTION (provided by applicant): Electronic Health Record (EHR)-based asynchronous messaging is a form of secure, email-style message exchange used widely by healthcare teams to communicate time-sensitive patient information without requiring sender and receiver to engage simultaneously. Asynchronous alerts are messages whose primary goal is to prompt timely, relevant healthcare team action aimed at improving patient outcomes. Unlike alerts that interrupt users mid-task, asynchronous alerts are delivered to a secure electronic "In-Basket" where they wait to be opened. While numerous studies describe interruptive alerts, little is known about the use, impact and risk of asynchronous alerts. This is an important gap. Often asynchronous alerts serve as the only notification to healthcare team members of time-sensitive issues; unopened alerts represent a potentially dangerous communication breakdown. Through previous AHRQ funding (R18 HS017203) we implemented an alert intervention notifying primary care teams of medication safety concerns and the need for close office follow-up post hospitalization. Automated asynchronous alerts were sent following 1282 hospital discharges of elderly patients but we found no evidence of an impact on patient outcomes. Preliminary review showed that 40% of staff-directed alerts and 19% of primary care provider alerts remained unopened at the end of day 1 post- delivery. A variety of sociotechnical factors likely influenced alert opening and subsequent actions. We compiled a rich collection of data with detailed information on alerts, the discharges triggering those alerts, contextual factors (e.g. number of unopened messages in the recipient's "In-Basket" at the time of alert delivery), patient and provider characteristics, and clinical outcome data. We enriched this data with electronic tracking data ("digital crumbs") recording the date and time of the creation and review of EHR data elements. We propose a secondary data analysis to identify contextual factors, types of alerts and characteristics of providers, patients and hospital discharges that relate to (a) timely opening of alerts following receipt and (b) timely first responsive action after alerts are receive and opened. We will also conduct a sequential pattern analysis describing the relevant actions taken by healthcare providers immediately following alert opening. Finally, we will assess the relationship between timely first responsive action following opening of alerts and key patient outcomes (office visits, rehospitalization, ER and urgicare visits, and adverse drug events). Our study is timely and innovative in its proposed use of digital crumbs, a largely untapped data source that will allow us to identify points of communication breakdown on the alert-response pathway. Epic Systems Corporation, the EHR system from which we have gathered our data, stores medical information for close to 127 million patients or nearly 40% of the U.S. population. What our research team learns by using digital crumbs to track alert opening and response will be broadly applicable to healthcare teams and researchers across the nation, and will inform design and implementation of future asynchronous alert systems.