: Electronic health records (EHR) have come of age. Modern clinical practice requires a clinician to be mindful of best practices, and wary of excess utilization and cost. However, abundant data show that gaps exist between best evidence and practice, wide variations persist in clinical practice patterns, and escalation of healthcare costs continues largely unabated. The fundamental value proposition of IT in health care has come under increased scrutiny while it is increasingly accepted that the effective application of IT is critical for improved patient safety and quality. This application aims to better demonstrate the value of IT to the end-user clinician through creation of clinical decision support tools integrated with clinical documentation workflow, and through provision of physician performance feedback on quality and benchmarks in the EHR.
We aim to demonstrate value to the clinician, as well as to the goals of patient safety and quality, and address the combined needs of clinical workflow support and decision support with innovative EHR technology. We hypothesize that two EHR-based interventions: the first focusing on the impact of a forms-based, clinical documentation-centric, approach to decision support, and the second on providing clinician specific performance reports regarding guideline compliance and quality benchmark achievement at the point of care, will significantly increase the perceived value of EHR to the end-user clinician. We propose to address three related research questions to illuminate this area of inquiry: 1) can a usable EHR intervention be developed which provides clinical decision support in the context of clinical documentation workflow, and which integrates population-based performance feedback to the physician; 2) do such tools improve the capture of key data for clinical decision support and quality assessment, compliance with best practice guidelines, and the quality of clinical documentation, and 3) is the use of such tools cost-effective - is there an impact utilization of medications, tests, and procedures in the setting of either care provided for patients with acute respiratory illness (ARI), or coronary artery disease (CAD)? We believe these are fundamental value questions which are critical to the broad adoption of IT in practice. If the end-user does not perceive the value of these tools primarily in the clinical workflow, healthcare IT will never be adopted, and secondary gains in patient safety, quality, and costs will never be achieved. ? ? ?

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS015169-01
Application #
6890109
Study Section
Special Emphasis Panel (ZHS1-HSR-H (01))
Program Officer
Zayas-Caban, Teresa
Project Start
2004-09-30
Project End
2007-09-29
Budget Start
2004-09-30
Budget End
2005-09-29
Support Year
1
Fiscal Year
2004
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
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Linder, Jeffrey A; Rigotti, Nancy A; Schneider, Louise I et al. (2011) Clinician characteristics and use of novel electronic health record functionality in primary care. J Am Med Inform Assoc 18 Suppl 1:i87-90
Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B et al. (2010) Effects of documentation-based decision support on chronic disease management. Am J Manag Care 16:SP72-81
Horsky, Jan; McColgan, Kerry; Pang, Justine E et al. (2010) Complementary methods of system usability evaluation: surveys and observations during software design and development cycles. J Biomed Inform 43:782-90
Linder, Jeffrey A; Schnipper, Jeffrey L; Tsurikova, Ruslana et al. (2010) Self-reported familiarity with acute respiratory infection guidelines and antibiotic prescribing in primary care. Int J Qual Health Care 22:469-75
Linder, Jeffrey A; Schnipper, Jeffrey L; Tsurikova, Ruslana et al. (2010) Electronic health record feedback to improve antibiotic prescribing for acute respiratory infections. Am J Manag Care 16:e311-9
Linder, Jeffrey A; Schnipper, Jeffrey L; Tsurikova, Ruslana et al. (2009) Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial. Inform Prim Care 17:231-40
Wright, Adam; Bates, David W; Middleton, Blackford et al. (2009) Creating and sharing clinical decision support content with Web 2.0: Issues and examples. J Biomed Inform 42:334-46
Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B et al. (2008) ""Smart Forms"" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management. J Am Med Inform Assoc 15:513-23
Linder, Jeffrey; Schnipper, Jeffrey L; Volk, Lynn A et al. (2007) Clinical decision support to improve antibiotic prescribing for acute respiratory infections: results of a pilot study. AMIA Annu Symp Proc :468-72

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