Electronic Health Record-linked Decision Support for Communicating Genomic Data t

与电子健康记录相关的决策支持，用于交流基因组数据

• 批准号: 8772968
• 负责人: CASEY OVERBY TAYLOR
• 金额: $ 15.27万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772968
• 关键词: Electronic; Health; Record; linked; Decision

DESCRIPTION (provided by applicant): There are challenges to using clinical decision support to effectively communicate genomic data to clinicians. Our long-term goal is to understand the effect of using a clinical decision support system (CDSS) to facilitate effectively communicating genomic data on physician confidence to make informed health decisions. The specific objective of this proposal is to develop and evaluate the CDSS. Our approach will engage approximately 10 health IT champions who are members of the University of Maryland Medical System Clinical Decision Support Committee and 50 stakeholders including clinical research coordinators, endocrinologists, interventional cardiologists, diabetes educators, nurse practitioners, medical assistants, administrative staff, and other clinical professionals participating in two exemplar personalized medicine (PM) programs at the University of Maryland. Exemplar programs are the Personalized Diabetes Medicine Program that aims to identify and diagnose patients with highly penetrant genetic forms of diabetes and provide customized treatment, and the implementation arm of the Pharmacogenomics of Anti-Platelet Intervention Study, that aims to translate CYP2C19 genotype results into actionable antiplatelet prescribing decisions. The central hypothesis is that stakeholders involved in these PM programs will have better attitudes about our ability to effectively communicate genomic data to physicians after deploying the CDSS, than before. We are qualified to develop a CDSS for effectively communicating genomic data given our track record in developing genomic CDS. We are also uniquely situated to conduct this research given our experience studying genomic CDS with physicians and our ability to explore the CDSS in the context of two ongoing exemplar PM implementation programs. We will complete the following aims to test our hypothesis: Aim 1 we will employ user-centered approaches to design a prototype CDSS; Aim 2 we will formalize genomic knowledge for integration into the electronic health record (EHR); and Aim 3 we will integrate the finalized CDSS with the EHR. We will use a pre-/post- study design to assess the attitudes of health IT champions and stakeholders involved in exemplar PM programs. At the start and conclusion of the project, we will measure attitudes using a survey instrument informed by Normalization Process Theory that focuses on the work individuals and groups have to do for a new technology or practice to become embedded and sustained in routine practice. Major contributions of this work will be: (a) a prototype CDSS designed to effectively communicate genomic data to physicians; (b) executable genomic CDS knowledge and configured resources for use within our prototype CDSS; and (c) an answer for our central hypothesis that provides insight into stakeholder attitudes about our ability to effectively communicate genomic data to physicians after deploying the CDSS. This work is a key research area of interest of AHRQ, specifically, using health IT to improve healthcare decision-making through use of integrated data and knowledge management.

描述（由申请人提供）：使用临床决策支持向临床医生有效传达基因组数据存在挑战。我们的长期目标是了解使用临床决策支持系统 (CDSS) 的效果，以促进有效地传达基因组数据，让医生有信心做出明智的健康决策。该提案的具体目标是开发和评估 CDSS。我们的方法将吸引大约 10 名健康 IT 拥护者，他们是马里兰大学医疗系统临床决策支持委员会的成员，以及 50 名利益相关者，包括临床研究协调员、内分泌学家、介入心脏病专家、糖尿病教育者、执业护士、医疗助理、行政人员和其他人员。参与马里兰大学两个示范性个性化医疗 (PM) 项目的临床专业人员。典型项目包括个性化糖尿病医学项目，旨在识别和诊断具有高度渗透性遗传形式的糖尿病患者并提供定制治疗，以及抗血小板干预研究的药物基因组学的实施部门，旨在将 CYP2C19 基因型结果转化为可操作的结果抗血小板药物处方决定。中心假设是，在部署 CDSS 后，参与这些 PM 项目的利益相关者将对我们有效地将基因组数据传达给医生的能力抱有更好的态度。鉴于我们在开发基因组 CDS 方面的记录，我们有资格开发 CDSS 来有效地传达基因组数据。鉴于我们与医生一起研究基因组 CDS 的经验以及我们在两个正在进行的示范性 PM 实施计划的背景下探索 CDSS 的能力，我们也处于开展这项研究的独特位置。我们将完成以下目标来检验我们的假设： 目标 1 我们将采用以用户为中心的方法来设计原型 CDSS；目标 2 我们将正规化基因组知识，以便整合到电子健康记录 (EHR) 中；目标 3，我们将最终确定的 CDSS 与 EHR 相集成。我们将使用研究前/研究后设计来评估健康 IT 倡导者和参与示范 PM 项目的利益相关者的态度。在项目开始和结束时，我们将使用标准化过程理论提供的调查工具来衡量态度，该工具侧重于个人和团体为使新技术或实践嵌入并维持在日常实践中而必须做的工作。这项工作的主要贡献将是：(a) 一个原型 CDSS，旨在有效地将基因组数据传达给医生； (b) 可执行的基因组 CDS 知识和配置资源，供在我们的原型 CDSS 中使用； (c) 我们中心假设的答案，该假设提供了利益相关者对我们在部署 CDSS 后有效地向医生传达基因组数据的能力的态度的见解。这项工作是 AHRQ 感兴趣的一个关键研究领域，特别是利用健康 IT 通过集成数据和知识管理来改善医疗决策。