Pragmatic Study of Clinician Use of a Personalized Patient Decision Aid Integrated into the Electronic Health Record: An 8-Year Experience

Coylewright, Megan; Keevil, Jon G.; Xu, Keren; Dodge, Shayne E.; Frosch, Dominick L.; Field, Michael E.

doi:10.1089/tmj.2019.0112

Cited by 20 publications

(12 citation statements)

References 16 publications

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“…A future research study of real-world implementation should include a process evaluation, assessment of barriers and facilitators to use, and measurement of impacts on shared decision-making, patient-provider communication, and ICS adherence. However, based on findings from this study and existing literature on strategies for implementation of shared decision-making tools into routine clinical settings [67], including promising results from integration into electronic health records [73], our next step will be to integrate both tools into the evidence-based Electronic Asthma Management System (eAMS) [46] and evaluate impact. This patient-and provider-facing, electronic health record-integrated system will be leveraged to prompt eligible patients to complete the decision aid prior to the clinical visit, and prompt providers to use the conversation aid during that visit.…”

Section: Content Preferencesmentioning

confidence: 99%

A patient decision aid for mild asthma: Navigating a new asthma treatment paradigm

Gagné

Cheung

Kouri

et al. 2022

Respiratory Medicine

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In mild asthma, as-needed budesonide-formoterol offers similar protection from severe exacerbations as daily inhaled corticosteroids (ICS), with lower ICS exposure but slightly increased symptoms. We sought to develop an electronic decision aid to guide discussions about the pros and cons of these first-line options, while identifying and integrating user preferences. Methods: Following International Patient Decision Aid Standards, we created a mild asthma decision aid prototype comparing convenience, clinical outcomes, cumulative ICS dose exposure, costs, and side-effects of each option. After face validation, the prototype was iteratively adapted through rapid-cycle development. Each cycle consisted of a patient focus group and a primary care physician interview. We made user preference-based improvements after each round, until reaching a pre-set stopping criterion (no new critical issues identified). We then performed a summative qualitative content analysis. Results: Over 5 cycles, we recruited 21 asthma patients (12/21 women, 10/21 ≥ 60 years old) and 5 physicians. Serial changes included simplification and reduction of text and reading level, inclusion of an ICS "myths" section and elaboration of patient-friendly infographics for numerical comparisons. User preferences fell within Content, Format, and tool use Process themes. In response to decision-making preferences, we created a complementary one-page conversation aid for patient-provider use at the point-of-care. Conclusions: We present preference-based electronic patient decision and conversation aids for treatment of mild asthma. Our user preference analyses offer useful insights for development of such tools in other chronic diseases. These tools now require integration into point-of-care workflows for measurement of real-world uptake and impact.

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Section: Content Preferencesmentioning

confidence: 99%

A patient decision aid for mild asthma: Navigating a new asthma treatment paradigm

Gagné

Cheung

Kouri

et al. 2022

Respiratory Medicine

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“…Studies that have evaluated the integration of PDAs in EHRs have focused on measuring their use by clinicians [1,[18][19][20][21][22], measuring their impact on patient outcomes [23][24][25], or user testing the tool to improve the navigation and design in the EHR system [26][27][28][29]. The integration of 2 PDAs, namely the Statin Choice and Diabetes Medication Choice tools, in the EHR at the Mayo Clinic led to their increased use [18,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have argued that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs) [ 1 , 2 ]. The task of integrating third-party tools into EHRs is complex [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The integration of 2 PDAs, namely the Statin Choice and Diabetes Medication Choice tools, in the EHR at the Mayo Clinic led to their increased use [ 18 , 20 , 21 ]. Coylewright et al [ 1 ] also demonstrated an increased use and observed that adoption rates of an EHR-based HealthDecision tool steadily increased over an 8-year period, with a high rate of sustained implementation after the fifth use .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, we were only able to identify a few examples of PDAs being integrated into EHR systems [ 1 , 18 - 29 ]. Anecdotally, researchers and practitioners recognize that embedding PDAs in EHRs is a complex and time-consuming process; however, we could not identify the literature that described the required processes.…”

Section: Introductionmentioning

confidence: 99%

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Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems

Scalia¹,

Schubbe²,

Forcino³

et al. 2021

J Med Internet Res

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Background Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and time-consuming task; yet, the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems. Objective This study aims to identify the steps and time required to integrate a PDA into the Epic EHR system and examine facilitators and barriers to the integration effort. Methods We conducted a case study at 5 academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate the integration of the uterine fibroid Option Grid PDAs into clinician-facing menus. We scheduled regular meetings with the Epic software analysts and an expert Epic technologist to discuss how best to integrate the tools into Epic for use by clinicians with patients. The meetings were then recorded and transcribed. Two researchers independently coded the transcripts and field notes before categorizing the codes and conducting a thematic analysis to identify the facilitators and barriers to EHR integration. The steps were reviewed and edited by an Epic technologist to ensure their accuracy. Results Integrating the uterine fibroid Option Grid PDA into clinician-facing menus required an 18-month timeline and a 6-step process, as follows: task priority negotiation with Epic software teams, security risk assessment, technical review, Epic configuration; troubleshooting, and launch. The key facilitators of the process were the clinical champions who advocated for integration at the institutional level and the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard app platform (Health Level 7 Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources) as a means of integrating the Option Grid into existing systems. This standard platform enabled clinicians to access the tools by using single sign-on credentials and prevented protected health information from leaving the EHR. Key barriers were the lack of control over the Option Grid product developed by EBSCO (Elton B Stephens Company) Health; the periodic Epic upgrades that can result in a pause on new software configurations; and the unforeseen software problems with Option Grid (ie, inability to print the PDA), which delayed the launch of the PDA. Conclusions The integration of PDAs into the Epic EHR system requires a 6-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance from an experienced technologist, and a willing EHR software developer team.

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Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System

Martinez,

Montori,

Rodriguez

et al. 2024

J GEN INTERN MED

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Pragmatic Study of Clinician Use of a Personalized Patient Decision Aid Integrated into the Electronic Health Record: An 8-Year Experience

Cited by 20 publications

References 16 publications

A patient decision aid for mild asthma: Navigating a new asthma treatment paradigm

A patient decision aid for mild asthma: Navigating a new asthma treatment paradigm

Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems

Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System

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