Developing Flexible EHR Plug-ins to Re-Engineer Clinical Care and Research Workfl

开发灵活的 EHR 插件以重新设计临床护理和研究工作

• 批准号: 7950139
• 负责人: JOHN THOMAS BIGGER
• 金额: $ 48.17万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7950139
• 关键词: Address; Adverse event; Architecture; Awareness; Business Rules; Caring; Clinical; Clinical Investigator; Clinical Research; Communities; Conflict (Psychology); Data; Detection; Drug Interactions; Electronic Health Record; Electronics; Engineering; Environment; Goals; Informatics; Information Technology; Interdisciplinary Study; Intervention; Knowledge; Lead; Learning; Medical; Methods; Metric; Mission; Modeling; Names; Occupational activity of managing finances; Participant; Patient Care; Perception; Pharmaceutical Preparations; Primary Care Physician; Primary Health Care; Process; Provider; Research; Research Personnel; Safety; Schedule; Scientist; Screening procedure; Services; System; Technology; Testing; Time; Training; Translating; Translational Research; United States National Institutes of Health; Visit; Work; base; biomedical informatics; care delivery; clinical care; community based practice; comparative effectiveness; computerized; decision research; design; effectiveness research; empowered; flexibility; health disparity; improved; interoperability; knowledge base; model design; open source; patient safety; socioeconomics; tool; usability

DESCRIPTION (provided by applicant): Project Summary Clinician scientists transform clinical observations to clinical research and eventually medical advances. How- ever, the lack of time, training, and effective technology support are known barriers for more than 87% of primary care physicians to conduct research1, 2. Our goal is to diminish health disparities in primary care and clinical research by empowering clinicians in low socioeconomic communities to participate in frontline clinical research. We propose to develop flexible plug-ins for electronic health records (EHR) to help re-engineer clinical care and research workflows toward improved workflow efficiency and patient safety as well as reduced redundancy. Inadequate interoperability of processes and systems between clinical research and patient care can lead to costly redundant test orders and visits, and dangerous drug-drug interactions. In 2009, Conway and Clancy suggested that "use of requisite research will be most efficient and relevant if generated as a by-product of care delivery." (JAMA 09, Vol. 301, No.7). A meaningful fusion of clinical care and research workflows promises to avoid conflicts and to improve safety and efficiency for clinical research3. EHR plug-ins that support flexible data federation and workflow coordination between clinical research and patient care would (a) improve contextual awareness for both care providers and research personnel, (b) promote a safer environment for re- search participants by protecting them from adverse drug interactions between clinical prescriptions and re- search interventions, (c) improve workflow efficiency by eliminating redundant or conflicting tests or visits, and (d) enable synergetic coordination across care and research teams. Frontline clinician scientists could also serve as learning networks for accelerating dissemination of clinical research evidence into practice. Over the past decade, our team has established mature technology for improving the efficiency of clinical or research workflows, including EHR-based clinical research participants screening4, computerized representation of research protocols5-8 and clinical guidelines9, and an integrated research visit scheduling and financial management tool STEPS10, to name a few. Through our InterTrial research10-13, one of the NIH Roadmap initi- atives for re-engineering clinical research enterprise14, we have accumulated invaluable knowledge of clinical research workflows and identified practical needs for informatics support for community-based clinical re- search11-13. Given the nation's large-scale deployment of EHR starting year 2009, we are motivated to translate the above knowledge into agile research decision support methods that can flexibly work with most functional EHRs to directly address the research needs at community level. Therefore, our specific aims are to: 1. Create concerted patient care and clinical research workflow models, designed to promote awareness, information sharing and reuse, and activity coordination between patient care and clinical research; 2. Establish a standards-based knowledge base of business rules to support the re-engineered care/research workflow model by harmonizing the user needs of multiple stakeholders; 3. Design a flexible and scalable service-oriented architecture that can interoperate with the knowledge base of business rules and the EHR to provide research decision support for visit scheduling, adverse events detection, automated research form filling, and research participants screening; 4. Design and apply metrics to evaluate the utility, usability, usefulness, impact, and user perception of the integrated workflow and research decision support method among multiple stakeholders. We will build on a multidisciplinary collaboration between clinical investigators, clinical research coordinators, and biomedical informatics researchers to achieve the above aims. Our socio-technical approach marries the best of domain knowledge, user needs, and advanced informatics technology to support clinical research based on our understanding that information technology in itself is insufficient to improve workflows but must be driven by the needs of all stakeholders and various socio-technical factors. We believe our proposed research will substantially increase the capacity of comparative effectiveness research in community-based practice settings and improve the efficiency, safety, and ethnic diversity of clinical research, and ultimately help accomplish the translational research mission and bridge health disparity gaps.

描述（由申请人提供）：项目摘要临床医生科学家将临床观察结果转换为临床研究，并最终医疗进展。但是，缺乏时间，培训和有效的技术支持是超过87％的初级保健医生进行研究的障碍1，2。我们的目标是通过赋予低社会经济社区的临床医生的能力来减少初级保健和临床研究的健康差异，以参与前线临床研究。我们建议开发用于电子健康记录（EHR）的灵活插件，以帮助重新设计临床护理和研究工作流程，以提高工作流程效率和患者安全性以及减少冗余。 临床研究和患者护理之间过程和系统的互操作性不足可能导致昂贵的冗余测试订单和访问以及危险的药物相互作用。在2009年，康威（Conway）和克兰西（Clancy）建议“如果作为护理的副产品产生，使用必要的研究将是最有效和相关的。” （JAMA 09，第301卷，第7号）。临床护理和研究工作流的有意义的融合有望避免冲突并提高临床研究的安全性和效率3。 EHR插件支持临床研究和患者护理之间的灵活数据联合和工作流程协调的插件（a）将提高护理提供者和研究人员的上下文意识，（b）促进一个更安全的环境，以通过在临床处方和重新搜索措施之间（c）提高临床搜索效果，（c）量不良，（c）在不良药物相互作用的情况下（c）（c）（c）（c），（c）（c）（c）跨护理和研究团队的协调。一线临床医生科学家还可以作为学习网络，以加速对临床研究证据的传播。 在过去的十年中，我们的团队建立了成熟的技术来提高临床或研究工作流程的效率，包括基于EHR的临床研究参与者筛选4，计算机化研究协议5-8和临床指南9，以及集成的研究访问时间表计划和财务管理工具步骤10。通过我们的Interrial Research10-13，我们是重新设计临床研究Enterprise14的NIH路线图创始人之一，我们积累了对临床研究工作流程的宝贵知识，并确定了对基于社区的临床重新搜索的信息提供信息的实用需求。11-13。鉴于该国从2009年开始对EHR的大规模部署，我们有动力将上述知识转化为敏捷的研究决策支持方法，这些方法可以灵活地与大多数功能性EHR合作，以直接满足社区层面的研究需求。因此，我们的具体目的是： 1。创建一致的患者护理和临床研究工作流程模型，旨在促进意识，信息共享和重用以及患者护理与临床研究之间的活动协调； 2.建立基于标准的业务规则知识基础，以通过协调多个利益相关者的用户需求来支持重新设计的护理/研究工作流程模型； 3.设计一个灵活且可扩展的面向服务的体系结构，可以与业务规则的知识基础和EHR互操作，以为访问计划，不良事件检测，自动研究表填充和研究参与者筛选提供研究决策支持； 4.设计和应用指标来评估多个利益相关者之间对集成工作流程和研究决策支持方法的效用，可用性，有用性，影响和用户的看法。 我们将基于临床研究人员，临床研究协调员和生物医学信息学研究人员之间的多学科合作，以实现上述目标。我们的社会技术方法将最佳的领域知识，用户需求和先进的信息学技术结合在一起，以基于我们的理解，即信息技术本身不足以改善工作流程，但必须由所有利益相关者和各种社会技术因素的需求驱动。我们认为，我们拟议的研究将大大提高基于社区的实践环境中比较有效性研究的能力，并提高临床研究的效率，安全性和种族多样性，并最终有助于完成转化研究任务和桥梁健康差异差距。