Electronic Health Records Clinical Trial
Official title:
Veterans Affairs Integrated Medication Manager
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.
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