<i>CM-SHARE:</i> Development, Integration, and Adoption of an Electronic Health Record–Linked Digital Health Solution to Support Care for Diabetes in Primary Care

Liang, Shuting; Husby, Hannah; Delatorre-Reimer, Jake; Mosser, Cory A.; Hudnut, Andrew; Knobel, Kevin; MacDonald, Karen V.; Yan, Xiaowei

doi:10.2337/cd18-0057

Cited by 3 publications

(6 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…CM-SHARE development was motivated by the desire to design a dashboard with better data integration and an intuitive visual display to facilitate physician decisions and communication with patients [ 22 ]. We previously assessed the adoption in the pilot phase and identified the target patient population for which the CM-SHARE is most likely to be used [ 22 ]. In this study, the reduction in total EHR time using CM-SHARE was seen not only during pilot testing with physicians but also in the spread physicians who were neither individually trained as in the pilot phase nor frequently interacted with by the CM-SHARE study team.…”

Section: Discussionmentioning

confidence: 99%

“…When and for whom CM-SHARE was used was completely voluntary and up to a physician’s discretion. Details of CM-SHARE features and adoption have been previously published [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, we observed a significant reduction in physician EHR time in the examination room and no change in the total physician time in the examination room, implying that physicians are likely to have more time to communicate with patients, improving patient satisfaction. From qualitative data taken during the initial pilot [22], we know that 2 pilot providers describe using CM-SHARE for patient education and that users describe CM-SHARE as leading to better discussions with patients, which seems to hold true in spread physicians and may explain the reduction in time spent on the computer with no changes in overall time spent with the patient. These findings in the initial pilot users and spread sites further show that CM-SHARE is more valuable for patients with diabetes or hypertension-related encounters and less valuable for patients with dyslipidemia.…”

Section: Comparison With Prior Workmentioning

confidence: 99%

“…A well-designed and integrated digital tool can be sufficiently seamless so that the user feels unencumbered by the effort to open the additional platform and perceive the EHR and digital tool as one system [ 21 ]. Therefore, using principles of user-centered design, we developed Cardiometabolic Sutter Health Advanced Reengineered Encounter (CM-SHARE), a web-based application designed to simplify care delivery for patients with cardiometabolic conditions (DM, hypertension, and dyslipidemia) [ 22 ]. CM-SHARE extracts essential health data elements from the EHR in real time at the point of care and displays them in novel ways for both physicians and patients.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation

Yan¹,

Husby²,

Mudiganti³

et al. 2022

JMIR Med Inform

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Background Electronic health record (EHR) systems are becoming increasingly complicated, leading to concerns about rising physician burnout, particularly for primary care physicians (PCPs). Managing the most common cardiometabolic chronic conditions by PCPs during a limited clinical time with a patient is challenging. Objective This study aimed to evaluate a Cardiometabolic Sutter Health Advanced Reengineered Encounter (CM-SHARE), a web-based application to visualize key EHR data, on the EHR use efficiency. Methods We developed algorithms to identify key clinic workflow measures (eg, total encounter time, total physician time in the examination room, and physician EHR time in the examination room) using audit data, and we validated and calibrated the measures with time-motion data. We used a pre-post parallel design to identify propensity score–matched CM-SHARE users (cases), nonusers (controls), and nested-matched patients. Cardiometabolic encounters from matched case and control patients were used for the workflow evaluation. Outcome measures were compared between the cases and controls. We applied this approach separately to both the CM-SHARE pilot and spread phases. Results Time-motion observation was conducted on 101 primary care encounters for 9 PCPs in 3 clinics. There was little difference (<0.8 minutes) between the audit data–derived workflow measures and the time-motion observation. Two key unobservable times from audit data, physician entry into and exiting the examination room, were imputed based on time-motion studies. CM-SHARE was launched with 6 pilot PCPs in April 2016. During the prestudy period (April 1, 2015, to April 1, 2016), 870 control patients with 2845 encounters were matched with 870 case patients and encounters, and 727 case patients with 852 encounters were matched with 727 control patients and 3754 encounters in the poststudy period (June 1, 2016, to June 30, 2017). Total encounter time was slightly shorter (mean −2.7, SD 1.4 minutes, 95% CI −4.7 to −0.9; mean –1.6, SD 1.1 minutes, 95% CI −3.2 to −0.1) for cases than controls for both periods. CM-SHARE saves physicians approximately 2 minutes EHR time in the examination room (mean −2.0, SD 1.3, 95% CI −3.4 to −0.9) compared with prestudy period and poststudy period controls (mean −1.9, SD 0.9, 95% CI −3.8 to −0.5). In the spread phase, 48 CM-SHARE spread PCPs were matched with 84 control PCPs and 1272 cases with 3412 control patients, having 1119 and 4240 encounters, respectively. A significant reduction in total encounter time for the CM-SHARE group was observed for short appointments (≤20 minutes; 5.3-minute reduction on average) only. Total physician EHR time was significantly reduced for both longer and shorter appointments (17%-33% reductions). Conclusions Combining EHR audit log files and clinical information, our approach offers an innovative and scalable method and new measures that can be used to evaluate clinical EHR efficiency of digital tools used in clinical settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…When and for whom CM-SHARE was used was completely voluntary and up to a physician’s discretion. Details of CM-SHARE features and adoption have been previously published [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Comparison With Prior Workmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation

Yan¹,

Husby²,

Mudiganti³

et al. 2022

JMIR Med Inform

Self Cite

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Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead

Tharakan,

McPeek Hinz,

Zhu

et al. 2024

Health Affairs Scholar

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Diabetes Self-Management Education and Support (DSMES) programs are an effective, yet underutilized, resource to improve health outcomes and behaviors for people with diabetes. We examined the attendance and referral rates for people with diabetes to DSMES classes at an academic medical center, noting a 10% referral rate and 37% completion rate for those referred. We identified barriers to DSMES care at patient, provider, and health system levels. Current technology platforms and training fail to prioritize referrals to diabetes education; providers and people with diabetes are often unfamiliar with program content and benefits. Scheduling mechanisms often delay or lose interested patients in receiving vital education. Existing Medicare reimbursement strategies limit expansion of DSMES programs, generating significant wait times and limit capabilities for Diabetes Care and Education Specialists. We identify potential policy solutions and recommend alterations to existing referral and scheduling systems to expand existing technology platforms for DSMES programs and shift reimbursement policies to individualize and better support care for persons with diabetes.

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Electronic Health Record Technology Designed for the Clinical Encounter

et al. 2021

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Objectives:Advances in medical discoveries have bolstered expectations of precise and complete care, but delivering on such a promise for complex, chronic neurological care delivery requires solving last-mile challenges. We describe the iterative human-centered design and pilot process for MS neuroSHARE, a digital health solution that brings practical information to the point-of-care so clinicians and patients with multiple sclerosis (MS) can view, discuss and make informed decisions together.Methods:We initiated a comprehensive human-centered process to iteratively design, develop and implement a digital health solution for managing MS in the routine outpatient setting of the nonprofit Sutter Health system in Northern California. The human-centered co-design process included three phases: Discovery and Design, Development, and Implementation and Pilot. Stakeholders included Sutter Health’s Research Development and Dissemination team, academic domain experts, neurologists, patients with MS, and an Advisory Group.Results:MS neuroSHARE went live in November 2018. It included a patient- and clinician-facing web application that launches from the electronic health record, visually displays a patient’s data relevant to MS, and prompts the clinician to comprehensively evaluate and treat the patient. Both patients and clinicians valued the ability to jointly view patient-generated and other data. Preliminary results suggest that MS neuroSHARE promotes patient-clinician communication and more active patient participation in decision-making.Conclusions:Lessons learned in the design and implementation of MS NeuroSHARE are broadly applicable to the design and implementation of digital tools aiming to improve the experience of delivering and receiving high-quality care for complex, neurological conditions across large health systems.

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CM-SHARE: Development, Integration, and Adoption of an Electronic Health Record–Linked Digital Health Solution to Support Care for Diabetes in Primary Care

Cited by 3 publications

References 27 publications

Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation

Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation

Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead

Electronic Health Record Technology Designed for the Clinical Encounter

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