Open & Act: Tracking Healthcare Team Response to EHR Asynchronous Alerts

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• 批准号: 8807431
• 负责人: Sarah LeLeiko Cutrona
• 金额: $ 11.84万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 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/8807431
• 关键词: Open; Act; Tracking; Healthcare; Team

DESCRIPTION (provided by applicant): Electronic Health Record (EHR)-based asynchronous messaging is a form of secure, email-style message exchange used widely by healthcare teams to communicate time-sensitive patient information without requiring sender and receiver to engage simultaneously. Asynchronous alerts are messages whose primary goal is to prompt timely, relevant healthcare team action aimed at improving patient outcomes. Unlike alerts that interrupt users mid-task, asynchronous alerts are delivered to a secure electronic "In-Basket" where they wait to be opened. While numerous studies describe interruptive alerts, little is known about the use, impact and risk of asynchronous alerts. This is an important gap. Often asynchronous alerts serve as the only notification to healthcare team members of time-sensitive issues; unopened alerts represent a potentially dangerous communication breakdown. Through previous AHRQ funding (R18 HS017203) we implemented an alert intervention notifying primary care teams of medication safety concerns and the need for close office follow-up post hospitalization. Automated asynchronous alerts were sent following 1282 hospital discharges of elderly patients but we found no evidence of an impact on patient outcomes. Preliminary review showed that 40% of staff-directed alerts and 19% of primary care provider alerts remained unopened at the end of day 1 post- delivery. A variety of sociotechnical factors likely influenced alert opening and subsequent actions. We compiled a rich collection of data with detailed information on alerts, the discharges triggering those alerts, contextual factors (e.g. number of unopened messages in the recipient's "In-Basket" at the time of alert delivery), patient and provider characteristics, and clinical outcome data. We enriched this data with electronic tracking data ("digital crumbs") recording the date and time of the creation and review of EHR data elements. We propose a secondary data analysis to identify contextual factors, types of alerts and characteristics of providers, patients and hospital discharges that relate to (a) timely opening of alerts following receipt and (b) timely first responsive action after alerts are receive and opened. We will also conduct a sequential pattern analysis describing the relevant actions taken by healthcare providers immediately following alert opening. Finally, we will assess the relationship between timely first responsive action following opening of alerts and key patient outcomes (office visits, rehospitalization, ER and urgicare visits, and adverse drug events). Our study is timely and innovative in its proposed use of digital crumbs, a largely untapped data source that will allow us to identify points of communication breakdown on the alert-response pathway. Epic Systems Corporation, the EHR system from which we have gathered our data, stores medical information for close to 127 million patients or nearly 40% of the U.S. population. What our research team learns by using digital crumbs to track alert opening and response will be broadly applicable to healthcare teams and researchers across the nation, and will inform design and implementation of future asynchronous alert systems.

描述（由申请人提供）：基于电子健康记录（EHR）的异步消息传递是一种安全，电子邮件式的消息交换的一种形式，由医疗保健团队广泛使用，以传达时间敏感的患者信息，而无需发送发送者和接收者同时参与。异步警报是消息，其主要目标是提示及时，相关的医疗团队行动，以改善患者的结果。与警报不同的是，中断用户中任务中，异步警报将传递到安全的“式内部”“屏障”，他们在那里等待打开。尽管许多研究描述了中断警报，但对异步警报的使用，影响和风险知之甚少。这是一个重要的差距。通常，异步警报是对时间敏感问题的医疗团队成员的唯一通知；未打开的警报代表了潜在危险的沟通故障。通过以前的AHRQ资金（R18 HS017203），我们实施了一项警报干预措施，通知初级保健团队有关药物安全问题的问题，并需要在住院后进行近距离后续工作。在1282年出院老年患者出院后，自动化的异步警报被发送，但我们没有发现对患者预后产生影响的证据。初步审查显示，在交货后第1天结束时，有40％的人员指导警报和19％的初级保健提供者警报仍未打开。各种社会技术因素可能会影响警报的开放和随后的行动。我们收集了丰富的数据集，其中包含有关警报的详细信息，触发这些警报的放电，上下文因素（例如，在接受警报交付时，接收者的“式内置”中未打开的消息的数量），患者和提供者特征和临床结果数据。我们使用电子跟踪数据（“数字碎屑”）记录了EHR数据元素的创建日期和时间，使这些数据丰富了这些数据。我们提出了二级数据分析，以确定上下文因素，警报类型和提供者，患者和医院出院的特征，与（a）及时相关 收到收到后的警报和（b）接收和打开警报后及时的第一个响应措施。我们还将进行连续模式分析，描述警报开放后立即采取的医疗保健提供者采取的相关行动。最后，我们将评估警报打开和关键患者结果后及时的首次响应行动之间的关系（办公室访问，重新住宿，ER和urgicare访问与不良毒品事件）之间的关系。我们的研究在拟议使用数字碎屑的拟议中是及时且创新的，这是一种尚未开发的数据源，它将使我们能够在警报响应途径上识别通信分解点。 Epic Systems Corporation是我们收集数据的EHR系统，为近1.27亿患者或近40％的美国人群存储医疗信息。我们的研究团队通过使用数字碎屑跟踪警报开放和响应来了解的内容将广泛适用于全国医疗团队和研究人员，并将为未来异步警报系统的设计和实施提供信息。