1
|
Martinez KA, Montori VM, Rodriguez F, Tereshchenko LG, Kovach JD, Hurwitz HM, Rothberg MB. Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System. J Gen Intern Med 2024:10.1007/s11606-023-08597-3. [PMID: 38191974 DOI: 10.1007/s11606-023-08597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. OBJECTIVE To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record. DESIGN Cross-sectional study. PARTICIPANTS Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System. MAIN MEASURES Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient's 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5-7.5%), intermediate (7.5-20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use. KEY RESULTS Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3-22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03-1.04) and 10-year ASVCD risk (aOR for 5-7.5% versus < 5% risk: 1.28; 95%CI: 1.14-1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73-0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76-0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven. CONCLUSIONS Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
Collapse
Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Larisa G Tereshchenko
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey D Kovach
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael B Rothberg
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA
| |
Collapse
|
2
|
Maxwell L, Shreedhar P, Dauga D, McQuilton P, Terry RF, Denisiuk A, Molnar-Gabor F, Saxena A, Sansone SA. FAIR, ethical, and coordinated data sharing for COVID-19 response: a scoping review and cross-sectional survey of COVID-19 data sharing platforms and registries. Lancet Digit Health 2023; 5:e712-e736. [PMID: 37775189 PMCID: PMC10552001 DOI: 10.1016/s2589-7500(23)00129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/27/2023] [Accepted: 07/05/2023] [Indexed: 10/01/2023]
Abstract
Data sharing is central to the rapid translation of research into advances in clinical medicine and public health practice. In the context of COVID-19, there has been a rush to share data marked by an explosion of population-specific and discipline-specific resources for collecting, curating, and disseminating participant-level data. We conducted a scoping review and cross-sectional survey to identify and describe COVID-19-related platforms and registries that harmonise and share participant-level clinical, omics (eg, genomic and metabolomic data), imaging data, and metadata. We assess how these initiatives map to the best practices for the ethical and equitable management of data and the findable, accessible, interoperable, and reusable (FAIR) principles for data resources. We review gaps and redundancies in COVID-19 data-sharing efforts and provide recommendations to build on existing synergies that align with frameworks for effective and equitable data reuse. We identified 44 COVID-19-related registries and 20 platforms from the scoping review. Data-sharing resources were concentrated in high-income countries and siloed by comorbidity, body system, and data type. Resources for harmonising and sharing clinical data were less likely to implement FAIR principles than those sharing omics or imaging data. Our findings are that more data sharing does not equate to better data sharing, and the semantic and technical interoperability of platforms and registries harmonising and sharing COVID-19-related participant-level data needs to improve to facilitate the global collaboration required to address the COVID-19 crisis.
Collapse
Affiliation(s)
- Lauren Maxwell
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Priya Shreedhar
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Peter McQuilton
- Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Robert F Terry
- TDR, the Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - Alisa Denisiuk
- Faculty of Chemistry, Georg-August-Universität Göttingen, Göttingen, Germany
| | | | | | - Susanna-Assunta Sansone
- Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Electronic Health Records That Support Health Professional Reflective Practice: a Missed Opportunity in Digital Health. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 6:375-384. [PMID: 36744083 PMCID: PMC9892400 DOI: 10.1007/s41666-022-00123-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
A foundational component of digital health involves collecting and leveraging electronic health data to improve health and wellbeing. One of the central technologies for collecting these data are electronic health records (EHRs). In this commentary, the authors explore intersection between digital health and data-driven reflective practice that is described, including an overview of the role of EHRs underpinning technology innovation in healthcare. Subsequently, they argue that EHRs are a rich but under-utilised source of information on the performance of health professionals and healthcare teams that could be harnessed to support reflective practice and behaviour change. EHRs currently act as systems of data collection, not systems of data engagement and reflection by end users such as health professionals and healthcare organisations. Further consideration should be given to supporting reflective practice by health professionals in the design of EHRs and other clinical information systems.
Collapse
|
4
|
Lee CN, Sullivan J, Foraker R, Myckatyn TM, Olsen MA, Phommasathit C, Boateng J, Parrish KL, Rizer M, Huerta T, Politi MC. Integrating a Patient Decision Aid into the Electronic Health Record: A Case Report on the Implementation of BREASTChoice at 2 Sites. MDM Policy Pract 2022; 7:23814683221131317. [PMID: 36225966 PMCID: PMC9549192 DOI: 10.1177/23814683221131317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Patient decision aids can support shared decision making and improve decision quality. However, decision aids are not widely used in clinical practice due to multiple barriers. Integrating patient decision aids into the electronic health record (EHR) can increase their use by making them more clinically relevant, personalized, and actionable. In this article, we describe the procedures and considerations for integrating a patient decision aid into the EHR, based on the example of BREASTChoice, a decision aid for breast reconstruction after mastectomy. BREASTChoice's unique features include 1) personalized risk prediction using clinical data from the EHR, 2) clinician- and patient-facing components, and 3) an interactive format. Integrating a decision aid with patient- and clinician-facing components plus interactive sections presents unique deployment issues. Based on this experience, we outline 5 key implementation recommendations: 1) engage all relevant stakeholders, including patients, clinicians, and informatics experts; 2) explicitly and continually map all persons and processes; 3) actively seek out pertinent institutional policies and procedures; 4) plan for integration to take longer than development of a stand-alone decision aid or one with static components; and 5) transfer knowledge about the software programming from one institution to another but expect local and context-specific changes. Integration of patient decision aids into the EHR is feasible and scalable but requires preparation for specific challenges and a flexible mindset focused on implementation. Highlights Integrating an interactive decision aid with patient- and clinician-facing components into the electronic health record could advance shared decision making but presents unique implementation challenges.We successfully integrated a decision aid for breast reconstruction after mastectomy called BREASTChoice into the electronic health record.Based on this experience, we offer these implementation recommendations: 1) engage relevant stakeholders, 2) explicitly and continually map persons and processes, 3) seek out institutional policies and procedures, 4) plan for it to take longer than for a stand-alone decision aid, and 5) transfer software programming from one site to another but expect local changes.
Collapse
Affiliation(s)
- Clara N. Lee
- Clara N. Lee, Department of Plastic and
Reconstructive Surgery, College of Medicine, Division of Health Services
Management and Policy, College of Public Health, The Ohio State University, 915
Olentangy River Rd, Ste 2100, Columbus, OH 43212, USA.
| | - Janessa Sullivan
- Division of Plastic and Reconstructive Surgery,
Department of Surgery, Washington University School of Medicine, Saint
Louis, MO, USA
| | - Randi Foraker
- Division of General Medical Sciences,
Department of Medicine, Washington University School of Medicine, Saint
Louis, MO, USA
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery,
Department of Surgery, Washington University School of Medicine, Saint
Louis, MO, USA,Division of General Medical Sciences,
Department of Medicine, Washington University School of Medicine, Saint
Louis, MO, USA
| | - Margaret A. Olsen
- Division of Public Health Sciences, Department
of Surgery, Washington University School of Medicine, Saint Louis, MO,
USA,Department of Family and Community Medicine,
Department of Biomedical Informatics, College of Medicine, The Ohio State
University, Columbus, OH, USA
| | | | - Jessica Boateng
- Division of Public Health Sciences, Department
of Surgery, Washington University School of Medicine, Saint Louis, MO,
USA
| | - Katelyn L. Parrish
- Division of Public Health Sciences, Department
of Surgery, Washington University School of Medicine, Saint Louis, MO,
USA
| | - Milisa Rizer
- Division of Infectious Diseases, Department of
Medicine, Washington University School of Medicine, Saint Louis, MO,
USA
| | - Tim Huerta
- Department of Biomedical Informatics,
Washington University School of Medicine, Saint Louis, MO, USA
| | - Mary C. Politi
- Division of Public Health Sciences, Department
of Surgery, Washington University School of Medicine, Saint Louis, MO,
USA
| |
Collapse
|
5
|
Moler-Zapata S, Grieve R, Lugo-Palacios D, Hutchings A, Silverwood R, Keele L, Kircheis T, Cromwell D, Smart N, Hinchliffe R, O'Neill S. Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery. Med Decis Making 2022; 42:1010-1026. [PMID: 35607984 PMCID: PMC9583279 DOI: 10.1177/0272989x221100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Electronic health records (EHRs) offer opportunities for comparative
effectiveness research to inform decision making. However, to provide useful
evidence, these studies must address confounding and treatment effect
heterogeneity according to unmeasured prognostic factors. Local instrumental
variable (LIV) methods can help studies address these challenges, but have
yet to be applied to EHR data. This article critically examines a LIV
approach to evaluate the cost-effectiveness of emergency surgery (ES) for
common acute conditions from EHRs. Methods This article uses hospital episodes statistics (HES) data for emergency
hospital admissions with acute appendicitis, diverticular disease, and
abdominal wall hernia to 175 acute hospitals in England from 2010 to 2019.
For each emergency admission, the instrumental variable for ES receipt was
each hospital’s ES rate in the year preceding the emergency admission. The
LIV approach provided individual-level estimates of the incremental
quality-adjusted life-years, costs and net monetary benefit of ES, which
were aggregated to the overall population and subpopulations of interest,
and contrasted with those from traditional IV and risk-adjustment
approaches. Results The study included 268,144 (appendicitis), 138,869 (diverticular disease),
and 106,432 (hernia) patients. The instrument was found to be strong and to
minimize covariate imbalance. For diverticular disease, the results differed
by method; although the traditional approaches reported that, overall, ES
was not cost-effective, the LIV approach reported that ES was cost-effective
but with wide statistical uncertainty. For all 3 conditions, the LIV
approach found heterogeneity in the cost-effectiveness estimates across
population subgroups: in particular, ES was not cost-effective for patients
with severe levels of frailty. Conclusions EHRs can be combined with LIV methods to provide evidence on the
cost-effectiveness of routinely provided interventions, while fully
recognizing heterogeneity. Highlights
Collapse
Affiliation(s)
- Silvia Moler-Zapata
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Lugo-Palacios
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - A Hutchings
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Luke Keele
- University of Pennsylvania, Philadelphia, USA
| | - Tommaso Kircheis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Neil Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
6
|
Kinney AR, Fields B, Juckett L, Read H, Martino MN, Weaver JA. Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy. Am J Occup Ther 2022; 76:23117. [PMID: 34962517 DOI: 10.5014/ajot.2022.049071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.
Collapse
Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Assistant Professor, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, School of Education, University of Wisconsin-Madison
| | - Lisa Juckett
- Lisa Juckett, PhD, OTR/L, CHT, is Assistant Professor, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Halley Read
- Halley Read, MOT, OTR/L, is Clinical Assistant Professor, School of Occupational Therapy, College of Health Professions, Pacific University, Hillsboro, OR
| | - M Nicole Martino
- M. Nicole Martino, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy Education, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha
| | - Jennifer A Weaver
- Jennifer A. Weaver, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins
| |
Collapse
|
7
|
Reese TJ, Schlechter CR, Kramer H, Kukhareva P, Weir CR, Del Fiol G, Caverly T, Hess R, Flynn MC, Taft T, Kawamoto K. Implementing lung cancer screening in primary care: needs assessment and implementation strategy design. Transl Behav Med 2021; 12:187-197. [PMID: 34424342 DOI: 10.1093/tbm/ibab115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography (CT) could help avert thousands of deaths each year. Since the implementation of screening is complex and underspecified, there is a need for systematic and theory-based strategies. Explore the implementation of lung cancer screening in primary care, in the context of integrating a decision aid into the electronic health record. Design implementation strategies that target hypothesized mechanisms of change and context-specific barriers. The study had two phases. The Qualitative Analysis phase included semi-structured interviews with primary care physicians to elicit key task behaviors (e.g., ordering a low-dose CT) and understand the underlying behavioral determinants (e.g., social influence). The Implementation Strategy Design phase consisted of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Three key task behaviors and four behavioral determinants emerged from 14 interviews. Implementation strategies were designed to target multiple levels of influence. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy toward ordering a low-dose CT, increasing social influence toward performing shared decision making and using the decision aid, and addressing key facilitators to using the decision aid. This study contributes knowledge about theoretical determinants of key task behaviors associated with lung cancer screening. We designed implementation strategies according to causal pathways that can be replicated and tested at other institutions. Future research is needed to evaluate the effectiveness of these strategies and to determine the contexts in which they can be effectively applied.
Collapse
Affiliation(s)
- Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37203, USA
| | - Chelsey R Schlechter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA.,Center for Health Outcomes and Population Equity, University of Utah, Salt Lake City, UT 84112, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Polina Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Tanner Caverly
- Department of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C Flynn
- Community Physicians Group, University of Utah, Salt Lake City, UT 84112, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| |
Collapse
|
8
|
Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis. Cancer Causes Control 2021; 32:1333-1345. [PMID: 34313875 DOI: 10.1007/s10552-021-01481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.
Collapse
|
9
|
Yan YH, Yang CW, Fang SC. Patient-centred e-health supports value cocreation and quality of medical care in Taiwan. Health Info Libr J 2021; 39:68-78. [PMID: 34117697 DOI: 10.1111/hir.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-centred e-health (PCEH) focusses on the interaction between patients and physicians. However, only a limited number of studies have focussed on the design of physician-patient value cocreation mechanisms in the PCEH context. Thus, we extend Grönroos' concept of value cocreation to understand how PCEH might improve the quality of care. OBJECTIVES This study proposes a theoretical framework to embody PCEH-supported value cocreation and presents some empirical validation. We expect that PCEH-supported value cocreation should comprise capabilities for patient empowerment, intention for information sharing, complementation for checking and verifying information, and interaction for shared understanding. METHODS This study surveyed a small group of patients that have used PCEH, 'My Health Bank' in Taiwan. The questionnaires were delivered to patients in hospitals (n = 167 questionnaires, 98% response rate). RESULTS Results indicate that certain PCEH-supported value cocreation mechanisms-capabilities for patient empowerment and interaction for shared understanding-affect the perceived quality of medical care. LIMITATIONS The survey only considered patient perceptions of value cocreation. CONCLUSION This study shows the patient perception of value cocreation in patient-centred e-Health. Further research needs to validate the framework for health professionals and in other e-Health record information sharing settings.
Collapse
Affiliation(s)
- Yu-Hua Yan
- Superintendent Office, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Chen-Wei Yang
- Department of Health Business Administration, Fooyin University, Kaohsiung City, Taiwan
| | - Shih-Chieh Fang
- Department of Business Administration, National Cheng Kung University, Tainan City, Taiwan
| |
Collapse
|
10
|
Scalia P, Ahmad F, Schubbe D, Forcino R, Durand MA, Barr PJ, Elwyn G. Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems. J Med Internet Res 2021; 23:e22766. [PMID: 33938806 PMCID: PMC8129884 DOI: 10.2196/22766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Glyn Elwyn
- Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
11
|
Fowler JC, Madan A, Bruce CR, Frueh BC, Kash B, Jones SL, Sasangohar F. Improving Psychiatric Care Through Integrated Digital Technologies. J Psychiatr Pract 2021; 27:92-100. [PMID: 33656814 DOI: 10.1097/pra.0000000000000535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This manuscript provides an overview of our efforts to implement an integrated electronic monitoring and feedback platform to increase patient engagement, improve care delivery and outcome of treatment, and alert care teams to deterioration in functioning. Patients First utilizes CareSense, a digital care navigation and data collection system, to integrate traditional patient-reported outcomes monitoring with novel biological monitoring between visits to provide patients and caregivers with real-time feedback on changes in symptoms such as stress, anxiety, and depression. The next stage of project development incorporates digital therapeutics (computerized therapeutic interventions) for patients, and video resources for primary care physicians and nurse practitioners who serve as the de facto front line for psychiatric care. Integration of the patient-reported outcomes monitoring with continuous biological monitoring, and digital supports is a novel application of existing technologies. Video resources pushed to care providers whose patients trigger a symptom severity alert is, to our knowledge, an industry first.
Collapse
|
12
|
Tsai CH, Eghdam A, Davoody N, Wright G, Flowerday S, Koch S. Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content. Life (Basel) 2020; 10:E327. [PMID: 33291615 PMCID: PMC7761950 DOI: 10.3390/life10120327] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.
Collapse
Affiliation(s)
- Chen Hsi Tsai
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Aboozar Eghdam
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Nadia Davoody
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Graham Wright
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Stephen Flowerday
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Sabine Koch
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| |
Collapse
|
13
|
Butler JM, Gibson B, Lewis L, Reiber G, Kramer H, Rupper R, Herout J, Long B, Massaro D, Nebeker J. Patient-centered care and the electronic health record: exploring functionality and gaps. JAMIA Open 2020; 3:360-368. [PMID: 33215071 DOI: 10.1093/jamiaopen/ooaa044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. Materials and Methods We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. Results Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. Discussion and Conclusion There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.
Collapse
Affiliation(s)
- Jorie M Butler
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Lacey Lewis
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Gayle Reiber
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rand Rupper
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Herout
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Brenna Long
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - David Massaro
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Jonathan Nebeker
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| |
Collapse
|
14
|
Lamba AH, Muralidhar K, Jain A, Tang F, Gomez-Marin O, Levis S, Dang S. Characteristics of Women Enrolled in a Patient Portal Intervention for Menopause. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:500-510. [PMID: 33786517 PMCID: PMC7784774 DOI: 10.1089/whr.2020.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
Background: We developed a 6-month educational intervention addressing menopause and management of menopausal symptoms called "My HealtheVet to Enable And Negotiate for Shared decision-making" or MEANS. MEANS is offered through secure messaging via the My HealtheVet patient portal system. Materials and Methods: Women veterans aged 45-60 years registered at the Miami, West Palm Beach, and Orlando Veterans Affairs Healthcare Systems (VAHS). Intervention group: women in the Miami VAHS enrolled in My HealtheVet who were sent an invitation, agreed to participate, and completed the baseline survey. Comparison group: women from the Miami, West Palm Beach, and Orlando VAHS who responded to the baseline survey. Results: The intervention group enrolled 269 women at Miami VAHS: average age 53.2 years; 42.4% white, 43.1% black, and 24.2% Hispanic; 95.9% already used My Healthe Vet. The Comparison group had 590 women: average age 53.8 years; 70.8% white, 20.7% black, and 10.2% Hispanic; 57.6% already used My Healthe Vet. Conclusions: The differences between the intervention and comparison groups likely represent the regional demographic variations and the disparate recruitment techniques adopted for the two groups. Using within- and between-group comparisons at the end of the 6-month intervention, this novel project will evaluate the feasibility of a patient portal intervention on knowledge and shared decision-making regarding menopause among racially and ethnically diverse women. The study highlights the scalable and enormous potential for patient portals in nonurgent chronic disease management and shared decision-making, important in the existing health care climate, wherein "meaningful use" of electronic health records is mandated. Because of the COVID-19 pandemic, medical care has abruptly changed to telehealth and this approach to patient education is more relevant now than ever before. This quality improvement project's registration number is ClinicalTrials.gov ID: NCT03109145.
Collapse
Affiliation(s)
| | - Kiranmayee Muralidhar
- Department of Public Health, and University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anika Jain
- Department of Public Health, and University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fei Tang
- Research Service, Miami Veterans Affairs Healthcare System, Miami, Florida, USA
| | - Orlando Gomez-Marin
- Department of Public Health, and University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Silvina Levis
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Geriatric Research, Education and Clinical Center (11 GRC), Miami Veterans Affairs Healthcare System, Miami, Florida, USA
| | - Stuti Dang
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Geriatric Research, Education and Clinical Center (11 GRC), Miami Veterans Affairs Healthcare System, Miami, Florida, USA
| |
Collapse
|
15
|
Rudin RS, Friedberg MW, Shekelle P, Shah N, Bates DW. Getting Value From Electronic Health Records: Research Needed to Improve Practice. Ann Intern Med 2020; 172:S130-S136. [PMID: 32479182 DOI: 10.7326/m19-0878] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Electronic health records (EHRs) are now widely adopted in the United States, but health systems have barely begun using them to deliver high-value care. More directed and rigorous research is needed to fulfill the promise of EHRs to not only store information but also support the delivery of better care. This article describes 4 potential benefits of EHR-based research: improving clinical decisions, supporting triage decisions, enabling collaboration among the care team (including patients), and increasing productivity via automation of tasks. Six recommendations are made for conducting and reporting research to catalyze value creation: develop interventions systematically by using user-centered design and a building-block approach; assess value in terms of cost, quality, outcomes, and work required of providers and patients; consider the time horizon for the intervention; test best practices for implementation in a range of real-world contexts; assess subtleties of behavior change tools used to improve high-value behaviors; and report the intervention in enough detail that it can be replicated, including context. Just as research played a critical role in developing early EHR prototypes and demonstrating their value to justify dissemination, research will continue to be essential in the next phase: expanding EHR-based interventions and maximizing their role in creating value.
Collapse
Affiliation(s)
| | - Mark W Friedberg
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts (M.W.F.)
| | | | - Neel Shah
- T.H. Harvard Chan School of Public Health, Boston, Massachusetts (N.S.)
| | - David W Bates
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (D.W.B.)
| |
Collapse
|
16
|
Abbasgholizadeh Rahimi S, Archambault PM, Ravitsky V, Lemoine ME, Langlois S, Forest JC, Giguère AMC, Rousseau F, Dolan JG, Légaré F. An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13321. [PMID: 31596249 PMCID: PMC6913686 DOI: 10.2196/13321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 05/25/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. OBJECTIVE In this mixed methods study, we aim to (1) assess women's needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. METHODS In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants' attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. RESULTS Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. CONCLUSIONS This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13321.
Collapse
Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche, Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
| | - Vardit Ravitsky
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Marie-Eve Lemoine
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Claude Forest
- Centre de recherche, Centre hospitalier universitaire de Québec, Québec, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Anik M C Giguère
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canadian Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
| |
Collapse
|
17
|
Dang S, Thavalathil B, Ruiz D, Gómez-Orozco C, Gómez-Marín O, Levis S. A Patient Portal Intervention for Menopause Knowledge and Shared Decision-Making. J Womens Health (Larchmt) 2019; 28:1614-1622. [PMID: 31390282 DOI: 10.1089/jwh.2018.7461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Menopause is a time often fraught with changes and symptoms, which may require difficult choices and decision-making. During this period, women would benefit from a better understanding and in-depth discussions with providers regarding menopause, associated conditions, and appropriate therapy. Patient portals offer a potential means to improve knowledge and shared decision-making (SDM) about menopause. Materials and Methods: This protocol article explores the feasibility of using the secure messaging (SM) function of the Veterans Affairs (VA) Patient Portal, "My HealtheVet" to implement an educational intervention and measure its impact on knowledge and SDM in the management of menopause. Results: This is a quality improvement pilot study in which women veterans of menopausal age in the Miami VA are offered an educational intervention via a patient portal, while women veterans in two neighboring VA facilities are not. Intervention participants receive weekly SMs with information on menopause symptoms, and treatment. After 6-months, all participants are surveyed on menopause knowledge, SDM, and satisfaction with the program. Conclusion: This study is among the first to assess the impact of an innovative patient portal intervention to improve knowledge and SDM between patients and providers regarding menopause. If successful, our program will add to the "meaningful use" of patient portals and offer a scalable and timely resource for SDM about menopause.
Collapse
Affiliation(s)
- Stuti Dang
- Geriatric Research, Education and Clinical Center (11 GRC), Miami Veterans Affairs Healthcare System, Miami, Florida.,Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Berry Thavalathil
- South Florida Veterans Affairs Foundation for Research and Education Miami, Florida
| | - Diana Ruiz
- Research Service, Miami VA Healthcare System, Miami, Florida
| | - Carlos Gómez-Orozco
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Orlando Gómez-Marín
- Division of Epidemiology and Public Health Science, University of Miami Miller School of Medicine, Miami, Florida
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center (11 GRC), Miami Veterans Affairs Healthcare System, Miami, Florida.,Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|