Assessing the Effect of Telemedicine on Physician EHR Work, Cognition, and Process Outcomes (ASPIRE)

评估远程医疗对医生 EHR 工作、认知和流程结果的影响 (ASPIRE)

基本信息

批准号：
10621374
负责人：
JULIA Rose ADLER-MILSTEIN
金额：
$ 34.04万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-12 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10621374
关键词：
Academic Medical Centers Address Ambulatory Care American COVID-19 pandemic California Caring Clinical Clinical assessments Cognition Communication Continuity of Patient Care Data Decision Making Diagnostic Diagnostic tests Documentation Electronic Health Record Evaluation Goals Guidelines Health Health system Healthcare Institution Interview Length Measures Mediating Modality Natural experiment Outcome Patient Care Patients Pattern Physicians Process Proxy Recording of previous events Sampling San Francisco Social Distance Structure Telemedicine Telephone Translating Uncertainty Universities Washington Work care delivery clinical decision-making cognitive load coronavirus disease data access design follow-up health care delivery health care service organization health data improved innovation medical specialties novel patient-clinician communication recruit virtual

项目摘要

PROJECT SUMMARY The Coronavirus disease 2019 (COVID-19) pandemic dramatically altered healthcare delivery in persistent ways. To adhere to the physical distancing guidelines and to provide continuity of patient care, organizations shifted the primary modality of ambulatory care to telemedicine-based virtual encounters. This transition has altered the structure, management, and delivery of patient care—with large potential changes to patient-provider communication and availability of clinical information. For example, during telemedicine encounters clinicians can no longer conduct physical exams or obtain vitals that inform clinical reasoning and decision making in routine ambulatory evaluation and management (E&M) encounters. In turn, these factors may contribute to clinical uncertainty, and thereby alter how the clinician leverages the electronic health record (EHR). They may need to engage in additional chart review to fill information gaps, enter patient-generated health data, or send more follow-up communications. One or more of these changes serves to intensify EHR-based cognitive load as EHR activities and activity switching increase, both at the encounter level and cumulatively over the course of a workday. In turn, greater EHR-based cognitive load could contribute to suboptimal clinical decisions (e.g., more diagnostic tests or referrals) and more errors (e.g., wrong-patient orders). In the proposed Assessing the Effect of Telemedicine on Physician EHR Work, Cognition, and Process Outcomes (ASPIRE) project, we investigate the primary hypothesis that ambulatory telemedicine encounters in the COVID context are associated with increased EHR-based cognitive load among clinicians, and downstream suboptimal clinical decisions and more frequent errors. We leverage novel, EHR-based audit log data from a 3- year period spanning pre- and COVID-periods (March 2019 – February 2022) to directly measure clinicians' EHR activities in telemedicine and face-to-face encounters at two large academic medical centers (Washington University in St Louis and University of California, San Francisco). Using the COVID-19 pandemic as a natural experiment that dramatically increased ambulatory telemedicine encounters (more than 25-fold at the two health systems), our first aim will characterize the differences in EHR-based activities between face-to-face and telemedicine encounters. We will then construct a derivative measure of EHR activity switches (within and across encounters) as a proxy measure of cognitive load and evaluate the downstream impact of cognitive load on clinical decision making and wrong-patient errors. The findings from these aims will be leveraged in our final “design” aim that uses frontline clinician interviews and a national expert eDelphi process to elicit the EHR-based factors impacting telemedicine encounters and to identify potential design strategies to address associated challenges. The eDelphi process will focus on translating and prioritizing the identified design strategies into pragmatic goals to improve EHR support for telemedicine encounters.

项目概要 2019 年冠状病毒病 (COVID-19) 大流行持续地极大地改变了医疗保健服务。为了遵守身体距离准则并提供患者护理的连续性，组织进行了转移从门诊护理到基于远程医疗的虚拟就诊的主要方式，这种转变改变了现状。患者护理的结构、管理和提供——患者提供者可能会发生巨大的变化例如，在远程医疗期间的沟通和可用性。无法再进行身体检查或生命体征来指导临床推理和决策反过来，这些因素可能会导致日常门诊评估和管理 (E&M) 的发生。临床不确定性，从而改变临床医生利用电子健康记录 (EHR) 的方式。需要进行额外的图表审查以填补信息空白、输入患者生成的健康数据或发送更多后续沟通。这些变化中的一项或多项有助于强化基于 EHR 的认知负荷。随着 EHR 活动和活动切换的增加，无论是在接触层面还是在整个过程中累积反过来，基于 EHR 的认知负荷可能会导致临床决策不理想（例如，更多的诊断测试或转诊）和更多的错误（例如，错误的患者医嘱）。在拟议的评估远程医疗对医生 EHR 工作、认知和流程的影响中结果（ASPIRE）项目，我们研究了流动远程医疗在以下情况中遇到的主要假设：新冠疫情背景与精英和下游基于 EHR 的认知负荷增加有关我们利用来自 3- 的新颖的、基于 EHR 的审计日志数据。跨越前期和新冠疫情期间（2019 年 3 月至 2022 年 2 月）的年份，直接测量信徒的 EHR 在两个大型学术医疗中心（华盛顿圣路易斯大学和加利福尼亚大学旧金山分校）将 COVID-19 大流行视为自然现象。一项实验极大地增加了门诊远程医疗的接触次数（两个健康中心的接触次数增加了 25 倍以上）系统），我们的首要目标是描述面对面和基于 EHR 的活动之间的差异然后，我们将构建 EHR 活动切换的衍生度量（内部和跨域）。遭遇）作为认知负荷的代理衡量标准，并评估认知负荷对下游的影响这些目标的结果将在我们的最终决策中得到利用。 “设计”目标是使用一线临床医生访谈和国家专家 eDelphi 流程来引出基于 EHR 的影响远程医疗遭遇的因素，并确定潜在的设计策略来解决相关问题 eDelphi 流程将侧重于将已确定的设计策略转化为优先级。改善 EHR 对远程医疗支持的务实目标。