Garabedian Pamela, Kain Jazzarae, Emani Srinivas, Singleton Stephanie, Rozenblum Ronen, Samal Lipika, Mueller Stephanie
Research Information Science & Computing, Mass General Brigham, 399 Revolution Drive, Somerville, MA, 02145, United States.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
JMIR Hum Factors. 2025 May 30;12:e67884. doi: 10.2196/67884.
The transfer of patients between hospitals, that is, interhospital transfer (IHT), introduces discontinuity of care, including gaps in health information transfer, which may worsen patient outcomes.
This is the first phase of a 5-year research study. Our goals are (1) to understand the gaps in health information exchange (HIE) and the clinician experience in accessing and using the electronic health record (EHR) during IHT and (2) to identify clinician user requirements for the development of an internal EHR solution for IHT.
We used prior work on HIE during IHT, coupled with a user-centered design (UCD) process to engage in discussions with clinical users and gather input on EHR workflow during IHT patient admission and planning. A total of 8 UCD sessions were held between February and July 2023, involving 18 clinicians who interact with the EHR during IHT, including 3 medicine residents, 10 advanced practice providers (APPs), and 5 direct care attendings-all responsible for caring for IHT patients at Brigham and Women's Hospital Cardiology, Medicine, Oncology, and intensive care unit services. Discussions highlighted facilitators and barriers and suggested improvements for data access and availability at the time of transfer. UCD sessions were recorded, analyzed, and coded by 2 independent reviewers to identify common themes driving suboptimal HIE. User requirements were derived from the sessions with users and iteratively refined throughout the process.
Qualitative analysis revealed that a significant number of frontline clinicians experience suboptimal availability of clinical information in the EHR at the time of IHT, including gaps in communication, incomplete data, and inefficient access to clinical data. User requirements emerged from these themes and primarily focused on information prioritization, data accessibility, and workflow and efficiency.
Notable levels of missing information and inefficient access to clinical data were reported by end users caring for IHT patients at the time of transfer. Conducting user research to understand the current process of IHT, involving users in conceptual design and information architecture, and generating prototypes for feedback from users can aid in designing a solution that meets user needs. The results of these early UCD activities will be used to develop and implement a data platform to support clinicians during IHT.
医院之间的患者转运，即院际转运（IHT），会导致医疗服务的不连续性，包括健康信息传递的 gaps，这可能会使患者预后恶化。
这是一项为期5年的研究的第一阶段。我们的目标是：（1）了解健康信息交换（HIE）中的 gaps 以及临床医生在院际转运期间访问和使用电子健康记录（EHR）的体验；（2）确定临床医生对开发用于院际转运的内部电子健康记录解决方案的用户需求。
我们利用先前关于院际转运期间健康信息交换的工作，结合以用户为中心的设计（UCD）流程，与临床用户进行讨论，并收集院际转运患者入院和规划期间电子健康记录工作流程的意见。2023年2月至7月期间共举行了8次UCD会议，涉及18名在院际转运期间与电子健康记录交互的临床医生，包括3名内科住院医师、10名高级实践提供者（APP）和5名直接护理主治医师，他们均负责在布莱根妇女医院心脏病科、内科、肿瘤科和重症监护病房服务中护理院际转运患者。讨论突出了促进因素和障碍，并提出了转运时数据访问和可用性方面的改进建议。UCD会议由2名独立评审员进行记录、分析和编码，以确定导致健康信息交换不理想的共同主题。用户需求来自与用户的会议，并在整个过程中反复完善。
定性分析表明，大量一线临床医生在院际转运时体验到电子健康记录中临床信息的可用性不理想，包括沟通 gaps、数据不完整以及临床数据访问效率低下。这些主题产生了用户需求，主要集中在信息优先级、数据可访问性以及工作流程和效率方面。
负责护理院际转运患者的终端用户报告了显著程度的信息缺失和临床数据访问效率低下的情况。开展用户研究以了解当前院际转运流程，让用户参与概念设计和信息架构，并生成原型以获取用户反馈，有助于设计出满足用户需求的解决方案。这些早期UCD活动的结果将用于开发和实施一个数据平台，以在院际转运期间支持临床医生。
