Timing of Electronic Health Record Integrated Decision Aid (Idea) for Stroke Prevention in Atrial Fibrillation Matters

Schott, Stacey L.; Xu, Keren; Berkowitz, Julia; Petersen, Curtis L.; Saunders, Catherine; Sobti, Navjot Kaur; Coylewright, Megan

doi:10.1016/s0735-1097(19)33611-3

Cited by 3 publications

(3 citation statements)

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“…Currently, there is increasing interest in decision aids for screening and treating chronic diseases, such as breast cancer (Elkin et al, 2017;Lin et al, 2022;Osaka & Nakayama, 2017;Sivell et al, 2012), stroke (Saposnik et al, 2016;Schott et al, 2019)and diabetes (Buse et al, 2021;Colmegna et al, 2023;Yu et al, 2020). However, there is lack of a systematic review of the characteristics, content and effectiveness of ACP decision aids applied in the field of palliative care.…”

Section: What Does This Paper Contribute To the Wider Global Clinical...mentioning

confidence: 99%

Exploration of decision aids to support advance care planning: A scoping review

Xu,

Han,

et al. 2024

Journal of Clinical Nursing

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BackgroundAdvance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision‐making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options.ObjectiveWhile decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research.DesignScoping review.MethodsThis scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA‐ScR list. Six English‐language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries.ResultsOf the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision‐making process satisfaction, but their feasibility has yet to be tested.ConclusionsDecision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision‐making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application.Reporting MethodThe paper has adhered to the EQUATOR guidelines and referenced the PRISMAg‐ScR checklist.No Patient or Public ContributionThis is a review without patient and public contribution.Registration: https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF.

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Section: What Does This Paper Contribute To the Wider Global Clinical...mentioning

confidence: 99%

Exploration of decision aids to support advance care planning: A scoping review

Xu,

Han,

et al. 2024

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…Nevertheless, we were only able to identify a few examples of PDAs being integrated into EHR systems [1,[18][19][20][21][22][23][24][25][26][27][28][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: 98%

“…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%

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

Scalia¹,

Schubbe²,

Forcino³

et al. 2020

Preprint

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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. CLINICALTRIAL

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Timing of Electronic Health Record Integrated Decision Aid (Idea) for Stroke Prevention in Atrial Fibrillation Matters

Cited by 3 publications

References 0 publications

Exploration of decision aids to support advance care planning: A scoping review

Exploration of decision aids to support advance care planning: A scoping review

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

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

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