A Turn-Key EHR Simulation Program to Reduce Diagnostic Error in Ambulatory Care

交钥匙 EHR 模拟程序可减少门诊护理中的诊断错误

• 批准号: 10005345
• 负责人: JEFFREY A. GOLD
• 金额: $ 39.72万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005345
• 关键词: Turn; Key; EHR; Simulation; Program

Project Summary: Diagnostic error is believed to be the most common type of patient safety event. Affecting between 5-10% of all patient encounters, it results in significant patient morbidity and mortality. Ambulatory care is especially susceptible to this, with diagnostic errors outnumbering other types 6:1 and 5% of patients seeking ambulatory care experiencing diagnostic error. Comprised of delayed and missed diagnosis, diagnostic error is frequently the consequence of the inability to effectively access and/or synthesize complex medical information for medical decision making. With the adoption of the HITECH Act over 95% of hospitals and 80% of office based practice utilize Electronic Health Records (EHRs) as their primary source of patient information. With the rapid expansion of EHRs, there is growing appreciation of the myriad of ways in which EHRs contribute to failures in information gathering and/or synthesis. These EHR use errors are often a combination of system design issues and poor user training. Simulation affords a powerful tool to both study, in a systematic way, the means in which EHRs contribute to said errors as well as provide a powerful training tool. We previously demonstrated that hi-fidelity EHR based simulation exercises in the ICU, using purposively designed EHR charts, uncovers the contribution of EHR use errors to diagnostic error. Participation in these exercises improves the recognition of embedded trends in patient information required for effective diagnostic accuracy by 50%. While we have created a number of simulation based exercises for critical care, the workflow, cognitive errors and EHR chart structure are fundamentally different for ambulatory care, representing a greater degree of longitudinal care and the need to process information acquired across multiple individual encounters. This places even more importance on information loss during transitions of care. Further, a number of barriers exist to implementation of EHR based simulation activities at most medical centers, an issue magnified in community practices. Therefore the goal of this proposal is to create and validate a turn-key library of EHR based simulations to improve diagnostic safety in ambulatory care which is both generalizable and scalable. In Aim #1, we will perform our problem analysis by using a combination of administrative data from the Pennsylvania Patient Safety Authority and claims data from The Doctors Company to identify diagnoses at risk for diagnostic error in ambulatory care and EHR use errors associated with said errors. We will integrate these data to create a rubric to allow for the design of a comprehensive EHR based simulation library to study and reduce diagnostic error across the 5 major ambulatory specialties. In Aim #2, we will develop these simulations for 5 ambulatory specialties. We will in-turn validate the ability of the simulation activities to serve as a training tool to fundamentally change EHR use patterns and reduce diagnostic error. Finally, this library, including all simulation materials, scripts and EHR charts will be coalesced into an online repository in Aim #3. We will further create a series of FHIR based applications which will facilitate “loading” of the simulated EHR charts into the major EHR systems. Thus, by the end of the funding period, we will have created a library of validated EHR base simulation exercises to reduce diagnostic error in ambulatory care and developed novel technology to facilitate widespread implementation.

项目摘要：诊断错误被认为是最常见的患者安全事件类型。影响之间 在所有患者遭遇中，有5-10％导致患者的发病率和死亡率很高。卧床护理尤其是 容易受到这种影响，诊断错误的人数超过其他类型6：1和5％的寻求门诊护理的患者 诊断错误。由延迟和错过的诊断组成，诊断错误通常是 无法有效访问和/或合成复杂的医疗信息以进行医疗决策的结果 制作。随着95％的医院和80％的基于办公室的实践的采用HITECH法案，利用了电子 健康记录（EHR）作为其患者信息的主要来源。随着EHR的快速扩展，正在增长 欣赏EHR有助于信息收集和/或综合的失败的多种方式。这些 EHR使用错误通常是系统设计问题和用户培训不佳的结合。模拟提供了强大的 以系统的方式研究两者的工具，EHR有助于上述错误并提供强大 培训工具。我们以前证明了ICU中基于Hi Fidelity EHR的模拟练习，通常使用 设计的EHR图表，发现了EHR使用错误对诊断错误的贡献。参加这些练习 将有效诊断准确性所需的患者信息中嵌入式趋势的识别提高了50％。 尽管我们为重症监护，但工作流，认知错误和EHR创建了许多基于模拟的练习 对于门诊护理而言，图表结构在根本上是不同的，代表了更大程度的纵向护理和 需要处理跨多个单独遇到的信息。这更重要 过渡期间的信息损失。此外，实施基于EHR的障碍存在许多障碍 大多数医疗中心的仿真活动，这个问题在社区实践中都放大。因此，目标的目标 建议是创建和验证基于EHR的仿真库，以提高卧床的诊断安全性 护理既可以推广又可扩展。在AIM＃1中，我们将使用组合来执行问题分析 宾夕法尼亚州患者安全局的行政数据，并向医生公司索赔数据 确定在门诊护理和EHR使用与上述错误相关的使用错误中诊断错误的诊断。我们将 集成了这些数据以创建一个标题，以允许设计基于EHR的综合仿真库来研究 并减少5个主要门诊专业中的诊断错误。在AIM＃2中，我们将为 5个卧床特色菜。我们将逐步验证模拟活动作为培训工具的能力 从根本上改变EHR使用模式并减少诊断错误。最后，这个库，包括所有模拟 材料，脚本和EHR图表将合并为AIM＃3的在线存储库。我们将进一步创建一系列 基于FHIR的应用程序将促进模拟EHR图表的“加载”到主要的EHR系统中。那是 在资金期结束时，我们将创建一个经过验证的EHR基础模拟练习的库，以减少 门诊护理中的诊断错误并开发了新型技术，以促进宽度实施。