A Human Factors Investigation of Health Information Exchange: Tools to Support Providers’ Coordination of Medications

健康信息交换的人为因素调查：支持提供者协调药物的工具

• 批准号: 9693609
• 负责人: MICHAEL WEINER
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9693609
• 关键词: Accountability; Adoption; Adverse drug event; Caring; Clinical; Cognition; Cognitive; Conflict (Psychology); Consumption; Data; Data Display; Decision Making; Ensure; Environment; Fostering; Foundations; Geography; Goals; Guidelines; Health; Health Personnel; Healthcare; Human; Informatics; Inpatients; Institution; Interview; Investigation; Investments; Knowledge; Medical; Medical center; Medication Errors; Medication Management; Methods; Outcome Measure; Outpatients; Patient risk; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Process; Process Measure; Provider; Psyche structure; Randomized Controlled Trials; Reporting; Research; Risk; Safety; Standardization; Techniques; Technology; Testing; Time; Translating; Veterans; Workload; cognitive process; data exchange; design; evidence base; health care service organization; improved; information display; medication safety; novel; operation; patient safety; programs; prototype; satisfaction; simulation; tool; usability; virtual

Background/Rationale: Millions of Veterans receive care from both VA and non-VA healthcare providers. Health information exchange (HIE) technologies are relatively new and are implemented across VA. HIE allows VA providers to send and receive medication data from non-VA medical institutions. This data exchange is important to coordinate patients' medications, reconcile medications to reflect what the patient is actually taking, and reduce the risk of adverse drug events. With the recent Veterans Access, Choice, and Accountability Act of 2014, it is even more critical to foster effective HIE that improves provider decision-making. Reports indicate, however, that VA's HIE technologies are inadequately supporting medication reconciliation tasks and are underutilized by providers. In addition, HIE medication data and VA medication orders are shown in separate displays, limiting the utility of HIE data and impeding providers' ability to coordinate medications. Objectives: The study objective is to identify providers' underlying cognitive needs in order to develop a set of technology design guidelines for presenting VA and HIE medication data. We hypothesize that, compared to current VA technologies, design guidelines from this research can significantly improve the quality and safety of providers' decision-making, including the efficiency and accuracy of medication reconciliation. Specific aims are as follows: Aim 1: Assess the strengths and weaknesses of VA's HIE interfaces for supporting providers' workflow and decision-making processes for medication reconciliation in the context of care. Aim 1 will yield an initial set of HIE design guidelines to support providers' workflow. Aim 2: Identify the cognitive strategies that providers use for medication reconciliation tasks. Aim 2 will yield an initial set of HIE design guidelines to support providers' cognition. Guidelines from Aims 1, 2 will be translated into a novel prototype for the VA-HIE interface. Aim 3: Evaluate the novel VA-HIE interface to assess whether the design guidelines significantly improve the quality and safety of providers' performance. Methods: For Aim 1, field observations, interviews, and remote usability tests will be conducted with inpatient and outpatient providers (prescribers and pharmacists) to generate a baseline, exploratory assessment of how well HIE interfaces support provider workflow. Qualitative data will be collected across four geographically dispersed VA Medical Centers. In Aim 2, card sorts and simulation interviews will be conducted with inpatient and outpatient providers to identify the underlying cognitive processes involved in medication reconciliation tasks. For Aim 3, we will conduct a randomized controlled trial with providers in a simulated environment and collect qualitative and quantitative data in order to evaluate whether the design guidelines significantly improves providers' efficiency and accuracy of medication reconciliation. Significance: This research will provide foundational knowledge on provider' cognition, which is necessary to ensure that VA and Veterans maximally benefit from VA's investment in HIE technologies. Study findings can be used to increase providers' adoption of HIE technologies and enhance the quality and safety of medication coordination for Veterans.

背景/理由：数百万退伍军人从VA和非VA医疗保健获得护理 提供者。健康信息交流（HIE）技术相对较新，并且是 跨VA实施。 Hie允许VA提供商从 非VA医疗机构。此数据交换对于协调患者很重要 药物，调和药物以反映患者实际服用的东西，并减少 不良毒品事件的风险。随着最近的退伍军人访问，选择和问责制 2014年，培养有效的HIE更为至关重要，可以改善提供商的决策。 但是，报告表明，VA的HIE技术不足以支持药物 和解任务，并被提供者不足。此外，HIE药物数据和VA 药物订单在单独的显示中显示，限制了HIE数据的效用并阻碍 提供者协调药物的能力。 目标：研究目标是确定提供者的基本认知需求 制定一套用于呈现VA和HIE药物数据的技术设计指南。我们 假设这是与当前的VA技术相比，这项研究的设计指南 可以显着提高提供商决策的质量和安全性，包括 药物对帐的效率和准确性。具体目的如下： 目标1：评估VA HIE接口的优势和劣势，以支持提供商 在护理背景下进行药物和解的工作流程和决策过程。 AIM 1将产生一组HIE设计指南，以支持提供商的工作流程。 目标2：确定提供者用于药物和解任务的认知策略。 AIM 2将产生最初的HIE设计指南，以支持提供者的认知。指南 从目标1中，2将转化为VA-HIE界面的新型原型。 目标3：评估新颖的VA-HIE界面以评估设计指南是否 显着提高了提供者绩效的质量和安全性。 方法：对于AIM 1，将进行现场观察，访谈和远程可用性测试 与住院和门诊提供者（处方者和药剂师）一起产生基线， HIE接口如何支持提供商工作流程的探索性评估。定性数据 将在四个地理分散的VA医疗中心收集。在AIM 2中，卡片 并将与住院和门诊提供者进行仿真访谈，以识别 药物和解任务涉及的基本认知过程。对于目标3，我们将 在模拟环境中向提供商进行随机对照试验并收集 定性和定量数据，以评估设计指南是否显着 提高提供者的效率和药物对帐的准确性。 意义：这项研究将提供有关提供者认知的基本知识，这是 确保VA和退伍军人从VA对Hie的投资中受益必要的必要 技术。研究结果可用于增加提供者对HIE技术的采用 并提高退伍军人药物协调的质量和安全性。