Use of Simulation to improve use and safety of Electronic Health Records

使用模拟来提高电子健康记录的使用和安全性

• 批准号: 8698771
• 负责人: JEFFREY A. GOLD
• 金额: $ 35万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8698771
• 关键词: Use; Simulation; improve; use; safety; Use; Simulation; improve; use; safety

DESCRIPTION (provided by applicant): In 2009, the Americans Recovery and Relief Act (ARRA) targeted universal adoption of Electronic Health Records (EHRs) by 2014-15. This is based on the perceived ability of EHRs to improve communication, create truly portable medical records and improve overall patient safety, especially through reducing errors in medication ordering and administration. However, there is a growing awareness, as highlighted in the 2011 Institute of Medicine (IOM) report on EHR safety, that there are many unintended consequences to EHR use, which may in turn actually increase medical errors and in some instances increase patient mortality. This report gave overall EHR safety a grade of C+. The increase in errors with EHR use are attributed to issues related to data-findings, adverse effects on communication and cognitive errors, all of which are accentuated through problems with the EHR- user interface and sub-optimal training. These issues have been best described in the Intensive Care Unit (ICU), where point in time and longitudinal data density, patient acuity, alert fatigue and need fo urgent decision making bring these issues to the forefront. Consequently, we hypothesized that high- fidelity EHR simulation training would be able to identify the extent for potential EHR use errors, provide a means for improved EHR use and serve as a framework for an iterative process to improve global EHR training and redesign within our institution. Preliminary data with a simulated 5-day Medical ICU patient documented that daily users correctly identified only 40% of errors and patient safety issues within a case, defining the scope of the problem. In this proposal, we plan to 1. Expand our initial EHR simulation station to allow for robust usability analysis (through video eye-tracking and key logging) and create additional cases to expand both in the MICU and other ICU environments, 2. To determine whether repeated testing can improve EHR use and error recognition within the ICU, 3. To employ usability data to redesign EHR training and user interface and 4. To convene a consensus conference to establish the role for EHR simulation to improve use, education and design.

描述（由申请人提供）：2009年，《美国人恢复与救济法》（ARRA）针对2014 - 15年度的电子健康记录（EHR）的普遍采用。这是基于EHR改善沟通，创建真正的便携式病历并提高整体患者安全的能力，尤其是通过减少药物订购和管理中的错误。但是，正如2011年医学研究所（IOM）关于EHR安全性的报告所强调的那样，人们的意识越来越大，EHR的使用会带来许多意想不到的后果，而EHR的使用实际上可能会增加医疗错误，并且在某些情况下会增加患者死亡率。该报告为总体EHR安全提供了C+等级。 EHR使用错误的增加归因于与数据调查有关的问题，对通信和认知错误的不利影响，所有这些问题都通过EHR-用户界面和亚最佳培训的问题加剧。这些问题在重症监护室（ICU）中最好地描述，其中时间点和纵向数据密度，患者敏锐度，警报疲劳以及需要紧急决策使这些问题成为最前沿。因此，我们假设高保真EHR模拟培训将能够确定潜在的EHR使用错误的程度，为改善EHR的使用提供了一种手段，并作为迭代过程的框架，以改善全球EHR培训并在我们机构内重新设计。使用模拟的5天医疗ICU患者的初步数据记录，每日用户在一个案例中仅正确识别了40％的错误和患者安全问题，从而定义了问题的范围。 In this proposal, we plan to 1. Expand our initial EHR simulation station to allow for robust usability analysis (through video eye-tracking and key logging) and create additional cases to expand both in the MICU and other ICU environments, 2. To determine whether repeated testing can improve EHR use and error recognition within the ICU, 3. To employ usability data to redesign EHR training and user interface and 4. To convene a consensus conference to establish the role for EHR模拟以改善使用，教育和设计。