Torres Gretchen W, Swietek Karen, Ubri Petry S, Singer Rachel F, Lowell Kristina H, Miller Wilhelmine
NORC at the University of Chicago.
EGEMS (Wash DC). 2014 Sep 25;2(3):1092. doi: 10.13063/2327-9214.1092. eCollection 2014.
The Beacon Community Cooperative Agreement Program supports interventions, including care-delivery innovations, provider performance measurement and feedback initiatives, and tools for providers and consumers to enhance care. Using a learning health system framework, we examine the Beacon Communities' processes in building and strengthening health IT (HIT) infrastructures, specifically successes and challenges in sharing patient information to improve clinical care.
In 2010, the Office of the National Coordinator for Health Information Technology (ONC) launched the three-year program, which provided $250 million to 17 Beacon Communities to invest in HIT and health information exchange (HIE) infrastructure. Beacon Communities used this funding to develop and disseminate HIT-enabled quality improvement practices found effective in particular community and practice environments.
NORC conducted 7 site visits, November 2012-March 2013, selecting Communities to represent diverse program features. From August-October 2013, NORC held discussions with the remaining 10 Communities. Following each visit or discussion, NORC summarized the information gathered, including transcripts, team observations, and other documents the Community provided, to facilitate a within-Community analysis of context and stakeholders, intervention strategies, enabling factors, and challenges.
Although each Community designed and implemented data-sharing strategies in a unique environment, similar challenges and enabling factors emerged across the Beacons. From a learning health system perspective, their strategies to build and strengthen data-sharing infrastructures address the following crosscutting priorities: promoting technical advances and innovations by helping providers adapt EHRs for data exchange and performance measurement with customizable IT and offering technical support to smaller, independent providers; engaging key stakeholders; and fostering transparent governance and stewardship of the infrastructure with neutral conveners.
While all the Communities developed or strengthened data-exchange infrastructure, each did this in a unique environment of existing health care market and legal factors. The Communities, however, encountered similar challenges and enabling factors. Organizations undertaking collaborative data sharing, performance measurement and clinical transformation can learn from the Beacon Communities' experience.
灯塔社区合作协议项目支持多种干预措施，包括护理交付创新、医疗服务提供者绩效评估与反馈举措，以及为医疗服务提供者和消费者提供的用以提升护理水平的工具。我们运用学习型健康系统框架，审视灯塔社区在构建和强化健康信息技术（HIT）基础设施方面的流程，特别是在共享患者信息以改善临床护理方面的成功经验和面临的挑战。
2010年，国家卫生信息技术协调办公室（ONC）启动了这项为期三年的项目，向17个灯塔社区提供了2.5亿美元，用于投资健康信息技术和健康信息交换（HIE）基础设施。灯塔社区利用这笔资金开发并推广了在特定社区和实践环境中被证明有效的、基于健康信息技术的质量改进实践。
2012年11月至2013年3月，美国国家民意研究中心（NORC）进行了7次实地考察，挑选了具有不同项目特征的社区。2013年8月至10月，NORC与其余10个社区进行了讨论。每次考察或讨论之后，NORC都会总结收集到的信息，包括文字记录、团队观察结果以及社区提供的其他文件，以便对社区内部的背景和利益相关者、干预策略、促成因素和挑战进行分析。
尽管每个社区都在独特的环境中设计并实施了数据共享策略，但在各个灯塔社区中出现了类似的挑战和促成因素。从学习型健康系统的角度来看，它们构建和强化数据共享基础设施的策略涉及以下几个贯穿各领域的优先事项：通过帮助医疗服务提供者采用可定制信息技术使电子健康记录（EHR）适应数据交换和绩效评估，并为规模较小的独立医疗服务提供者提供技术支持，来推动技术进步和创新；让关键利益相关者参与进来；以及通过中立的召集人促进基础设施的透明治理和管理。
虽然所有社区都开发或强化了数据交换基础设施，但每个社区都是在现有的医疗保健市场和法律因素的独特环境中进行的。然而，这些社区遇到了类似的挑战和促成因素。开展协作数据共享、绩效评估和临床转型的组织可以借鉴灯塔社区的经验。
