The technical landscape for patient-centered CDS: progress, gaps, and challenges

Abstract

Supporting healthcare decision-making that is patient-centered and evidence-based requires investments in the development of tools and techniques for dissemination of patient-centered outcomes research findings via methods such as clinical decision support (CDS). This article explores the technical landscape for patient-centered CDS (PC CDS) and the gaps in making PC CDS more shareable, standards-based, and publicly available, with the goal of improving patient care and clinical outcomes. This landscape assessment used: (1) a technical expert panel; (2) a literature review; and (3) interviews with 18 CDS stakeholders. We identified 7 salient technical considerations that span 5 phases of PC CDS development. While progress has been made in the technical landscape, the field must advance standards for translating clinical guidelines into PC CDS, the standardization of CDS insertion points into the clinical workflow, and processes to capture, standardize, and integrate patient-generated health data.

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

“…These findings highlight a risk that real-time benefit tools, if used by clinicians but not discussed with patients, could drive prescribing decisions that are not patient-centered but rather reflect prescribers' assumptions about their patient's needs. 17 We found that nearly all (89.0%) respondents said they would be comfortable or neutral regarding being screened for their interest in a medication cost conversation before their physician's visit. Prior studies have shown that physicians infrequently initiate cost conversations [18][19][20][21] and are concerned that patients may be uncomfortable with discussing treatment costs.…”

“…Respondents described varied levels of distress if their physician used the real-time benefit tool but did not discuss prices with them, with about equal proportions saying they would not be upset as said they would be very upset. These findings highlight a risk that real-time benefit tools, if used by clinicians but not discussed with patients, could drive prescribing decisions that are not patient-centered but rather reflect prescribers’ assumptions about their patient’s needs …”

Visualization of Patient-Generated Health Data: A Scoping Review of Dashboard Designs

“…PGHD can also offer providers more accurate measurements and temporal insight into a particular disease, 6 enabling clinicians to use the data to guide discussions with patients and use clinic time more efficiently. 6 7…”

“…First, integration with current EHRs and clinical workflows is limited, 6 which is a barrier to development of PC CDS centering on patients' individual needs. 7 Second, large volumes of automatically captured, high-frequency data can be time-consuming to view, and cognitively difficult to interpret, which contributes to clinician burnout. 8 Third, while clinical guidelines offer recommendations based on physiologic measurements obtained in outpatient clinic visits, 9 similar evidence-based interpretation of PGHD is lacking, hindering PGHD use in patient care.…”

“…PGHD can also offer providers more accurate measurements and temporal insight into a particular disease, 6 enabling clinicians to use the data to guide discussions with patients and use clinic time more efficiently. 6,7 There are several barriers that prevent the full benefits of PGHD from being realized in clinical care. First, integration with current EHRs and clinical workflows is limited, 6 which is a barrier to development of PC CDS centering on patients' individual needs.…”