Improving healthcare processes and outcomes by directly integrating health information exchange data in the clinical workflow

通过直接将健康信息交换数据集成到临床工作流程中来改善医疗保健流程和结果

• 批准号: 10267697
• 负责人: TITUS K. SCHLEYER
• 金额: $ 39.95万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10267697
• 关键词: Improving; healthcare; processes; outcomes; directly

Project Summary/Abstract For clinicians, using patient health information exchanged across healthcare systems is often cumbersome and disruptive. Systematic reviews report promising effects of health information exchange (HIE) on healthcare processes and outcomes, such as decreased repeat/unnecessary tests, costs, and admission/readmission rates. However, until HIE is widely and firmly integrated in the practice and workflow of clinicians, it is unlikely that we will fully realize the potential benefits of the significant investment in the adoption and use of health information technologies. Direct integration of HIE and electronic health records (EHR) has not been widely implemented and studied, offering the opportunity to measure how putting relevant and timely information directly at the clinician’s fingertips could impact care compared to traditional ways of accessing information in an HIE. The objective of our project is to evaluate a novel application called CareView that seamlessly integrates highly relevant information from the HIE directly with the EHR in the emergency department (ED). Our central hypothesis is that this HIE/EHR integration will increase HIE information use and improve care delivery, patient outcomes, and clinician satisfaction and efficiency compared to current methods of accessing HIE data. Our specific aims are to assess the impact of HIE/EHR integration on: (1) clinician perceptions and acceptance of HIE in the ED setting; (2) HIE use by ED clinicians; and (3) clinical care processes and outcomes in the ED. Based on our successful 2018 pilot implementation at Indiana University (IU) Health Methodist, the largest ED in the IU Health system, we will roll out CareView at additional IU Health EDs in waves of three to four sites for intervention periods of two months in a total of 14 IU Health EDs. Using a stepped-wedge, cluster non-randomized controlled study design, each site will serve as a control and, subsequently, intervention site. CareView supports the clinical conditions of chest pain, abdominal pain, weakness/ dizziness/ headache, back/ flank pain, pregnancy, arrhythmia and dyspnea, and we expect our study to involve approximately 139 clinicians during nearly 100,000 of the 370,000 annual ED visits in the IU Health system. Our project is significant because it will evaluate a method to efficiently and effectively retrieve relevant information from an HIE within an EHR; focus on the ED, where using HIE information is typically highly relevant and impactful; and generate evidence for the implementation and impact of interoperability, a key health IT focus of federal, state and other agencies. The project is innovative because it (1) seamlessly integrates HIE data with the EHR; (2) uses the novel Fast Healthcare Interoperability Resources (FHIR) standard, which the AHRQ has endorsed, to facilitate generalizability; and (3) employs a rigorous study design that allows us to make causal inferences about the impact of HIE/EHR integration. This project will promote the mission of the Agency for Healthcare Research and Quality (AHRQ) by providing real-world evidence regarding the causal effects of HIE on improving healthcare processes, quality and patient outcomes.

项目摘要/摘要 对于临床医生而言，使用跨医疗保健系统交换的患者健康信息通常很麻烦，并且 破坏性。系统评论报告健康信息交流的承诺影响（HIE）对医疗保健的影响 流程和结果，例如减少/不必要的测试，费用和入学/再入院 费率。但是，直到Hie广泛并首先集成到临床医生的实践和工作流程中，这不太可能 我们将充分意识到大量投资在采用和使用健康方面的潜在好处 信息技术。 HIE和电子健康记录（EHR）的直接整合并不广泛 实施和研究，提供了衡量相关和及时信息的机会 与访问信息的传统方式相比，直接处于临床的指尖可能会影响护理 一个。我们项目的目的是评估一个名为Careview的新颖应用程序，该应用程序无缝 直接与急诊科（ED）的EHR直接从HIE中综合了高度相关的信息。 我们的中心假设是，这种HIE/EHR集成将增加信息的使用并改善护理 与当前的访问方法相比 hie数据。我们的具体目的是评估HIE/EHR整合对：（1）临床看法和 在ED环境中接受Hie； （2）ED临床医生的使用； （3）临床护理过程和 ED的结果。基于我们在印第安纳大学（IU）Health成功实施的2018年飞行员实施 卫理公会是IU卫生系统中最大的ED 三到四个地点的波浪在两个月的干预期内，总共14个IU Health Eds。使用 阶梯式北方，群集非随机对照研究设计，每个站点都将作为控制，并且 随后，干预地点。 Careview支持胸痛，腹痛的临床状况， 弱/头晕/头痛，背部/侧面疼痛，怀孕，心律不齐和呼吸困难，我们希望我们的 在IU的370,000届ED访问中，近100,000次涉及大约139位临床医生的研究 卫生系统。我们的项目很重要，因为它将评估有效有效检索的方法 来自EHR中HIE的相关信息；专注于ED，其中使用HIE信息通常是 高度相关和有影响力；并为互操作性的实施和影响提供证据 联邦，州和其他机构的关键健康IT重点。该项目具有创新性，因为它（1）无缝 将HIE数据与EHR集成； （2）使用新颖的快速医疗保健互操作性资源（FHIR） AHRQ认可的标准，以促进普遍性； （3）员工严格的研究设计 这使我们能够对HIE/EHR整合的影响进行因果推断。这个项目将促进 医疗研究与质量机构（AHRQ）的任务通过提供现实世界证据 关于HIE对改善医疗保健过程，质量和患者结果的因果影响。