The purpose of this study is to advance the science of healthcare informatics and to improve medication management through the development of a new approach to the electronic medical record called the Integrated Medication Manager (IMM).
In an attempt to address problems patient non-compliance with quality goals barriers to access and integration of health information that impede achievement of treatment goals, the VA is developing a new approach to the electronic medical record. The VA is moving away from the paper-chart metaphor and towards an integrated representation of the patient's status and care process across time. One of the first steps in the development phase has been to explicitly relate patient conditions, therapies, and goals in the domain of pharmacotherapy. This is called Integrated Medication Management and draws on Hollnagel's Contextual Control Model. Providers will be able to plan care and create orders directly in the context of these explicit relationships. This application will be implemented nationwide through a web interface embedded within the existing Computerized Patient Record System (CPRS), the graphical user interface to VA Information Systems (VistA). Aim 1: Identify cognitive components of providers' therapeutic decision making in the field. Aim 2. Refine and evaluate the Integrated Medication Manager using simulation studies. * Aim 2.a. Refine interfaces and logic of the Integrated Medication Manager. * Aim 2.b. Compare the performance of the Integrated Medication Manager and usual CPRS. All hypotheses (below) test the use of IMM versus usual electronic medical record (EMR). * Speed of decision-making will be faster. * Accuracy of data interpretation (clinical assessment) will be higher. * Appropriateness of therapeutic plans will be higher. * Efficiency of gathering information will be higher. * Common ground measures will be higher. * Appropriateness of therapeutic plans will be higher when relevant data is outside the usual time horizon. * Appropriateness of therapeutic plans will be higher when complex associations among patient therapies and goals exist. * Appropriateness of therapeutic plans will be no lower when relevant data is not captured by the displays of the IMM. * Appropriateness of therapeutic plans will be higher when highly salient data is not germane to the most important problem. * Appropriateness of therapeutic plans will be higher when cognitive load is high due to interruptions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
58
A theory based electronic health record. Half of the provider participants were assigned the IMM to use. The other half were assigned the VA's CPRS EHR to use for the simulation. Providers were randomly assigned to a EHR to use.
VA SLC Health Care System
Salt Lake City, Utah, United States
Amount of Time to Complete Assessment and Plan
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan.
Time frame: 10 minutes
Accuracy of Written Assessment and Plan in Terms of Control and Status
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan. The primary outcome evaluated participants' recommendations for treatment of patient conditions. Participants reviewed a total of 10 patient cases and received a score between 0 and 3 points for each issue within each patient case. The final score for each participant was a proportion between 0 and 1. The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible. Higher values on the scale represent greater accuracy of the written assessment and plan.
Time frame: 10 minutes
Identification of Planned Monitoring and Follow up Encounters in Assessment and Plan
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan. . The secondary outcome evaluated participants' recommendation about future monitoring of patient conditions. Participants reviewed a total of 10 patient cases and received a score of 0 or 1 point for each issue within each case. The final score for each participant was a proportion between 0 and 1. The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible. Higher values on the scale represent a greater proportion of appropriate monitoring recommendations made.
Time frame: 10 minutes
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