Statewide Implementation of Electronic Health Records

全州范围内实施电子健康记录

• 批准号: 6948748
• 负责人: DAVID W., MD,Msc BATES
• 金额: $ 49.93万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2007-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6948748
• 关键词: age difference; automated medical record system; behavioral /social science research tag; clinical research; computer human interaction; computer program /software; computer system design /evaluation; cooperative study; gender difference; geographic difference; health care facility; health care personnel education; health care personnel performance; health care quality; health care service evaluation; health care service utilization; health services research tag; human subject; outpatient care; patient safety /medical error; physicians; population survey; reinforcer; rural area; urban area; age difference; automated medical record system; behavioral /social science research tag; clinical research; computer human interaction; computer program /software; computer system design /evaluation; cooperative study; gender difference; geographic difference; health care facility; health care personnel education; health care personnel performance; health care quality; health care service evaluation; health care service utilization; health services research tag; human subject; outpatient care; patient safety /medical error; physicians; population survey; reinforcer; rural area; urban area

DESCRIPTION (provided by the applicant): Electronic health records (EHRs) represent an essential tool for improving the safety and quality of health care, but most physicians in office practices do not currently use this technology. In Massachusetts, several large provider organizations utilize state-of-the art EHRs, but most physicians practicing solo or in small groups continue to rely on paper records. A statewide multi-stakeholder coalition has embarked on a separately funded program to facilitate the adoption of EHRs in the offices of all physicians throughout Massachusetts and to develop the interconnectivity infrastructure to enable the exchange of health information across the state. The intervention program, which involves establishing a system of financial incentives for physicians that adopt EHRs, is a collaborative effort among providers, insurers, and businesses in Massachusetts, in cooperation with the State government. This application proposes a rigorous evaluation of the impact of this statewide implementation program on EHR adoption by rural and non-rural ambulatory care practices in Massachusetts. This study will address the following questions: 1) Will an incentive-based collaborative intervention program facilitate more extensive and more rapid adoption of EHRs as compared with the "natural" rate of adoption? 2) To what extent will adoption of EHRs reduce medication errors and improve the quality of ambulatory health care? 3) What are the correlates of physician receptivity and use of EHRs? 4) Will an intensive program of educational outreach ("academic detailing") more effectively foster the adoption of EHRs and minimize the loss of physician productivity than standard EHR implementation programs? These questions will be addressed by a survey of all office practices in the state (N is approximately 6,000), comparative analysis of medication errors in 10 primary care practices, statewide practice quality data analysis (including HEDIS measures), survey to a stratified random sample of 2,000 physicians, and a randomized controlled trial of an academic detailing intervention in a total of 30 rural and non-rural practices. This program evaluation will provide much-needed information on the role of incentive programs and of educational outreach to facilitate the adoption of EHRs and related HIT in communities nationwide. Dissemination of the results of this work should speed efforts toward the establishment of a national health information infrastructure.

描述（由申请人提供）：电子健康记录（EHR）代表了改善医疗保健安全性和质量的重要工具，但是大多数办公室实践中的医生目前不使用此技术。在马萨诸塞州，几个大型提供商组织都利用了最先进的EHR，但是大多数从事独奏或小组的医生继续依靠纸质记录。一个全州的多方利益相关者联盟已开始了一项单独资助的计划，以促进在马萨诸塞州所有医师的办公室中采用EHR，并开发互连性基础设施以实现全州健康信息的交换。该干预计划涉及为采用EHRS的医师建立经济激励系统，是马萨诸塞州的提供者，保险公司和企业的合作努力，与州政府合作。 该申请提出了对本州实施计划对马萨诸塞州农村和非农村医疗保健实践采用EHR采用的影响的严格评估。这项研究将解决以下问题：1）与“自然”采用率相比，基于激励的协作干预计划是否会促进EHR的更广泛和更快的采用？ 2）EHR的采用将在多大程度上减少用药错误并提高门诊医疗保健的质量？ 3）医师接受和EHR的使用的相关性是什么？ 4）与标准EHR实施计划相比，一项密集的教育宣传计划（“学术细节”）会更有效地促进采用EHR并最大程度地减少医师生产力的损失吗？这些问题将通过对该州的所有办公实践的调查来解决（N约为6,000个），对10种初级保健实践中的药物错误的比较分析，全州范围的实践质量数据分析（包括HEDIS措施），对2,000名医师的分层随机样本进行了调查，以及对总计30种农村和非责任习惯进行的一项学术详细介绍的随机对照试验。 该计划评估将提供有关激励计划和教育宣传作用的急需信息，以促进在全国范围内采用EHR和相关的命中。传播这项工作的结果应加快为建立国家卫生信息基础设施的努力。