PDF(Pubmed)
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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
患者决策辅助工具可以支持共享决策并提高决策质量。然而,由于多重障碍，决策辅助在临床实践中并未广泛使用。将患者决策辅助工具集成到电子健康记录（EHR）中，可以通过使其更具临床相关性来增加其使用。个性化，和可操作的。在这篇文章中,我们描述了将患者决策辅助整合到EHR中的程序和考虑因素，以BREASTChoice为例,乳房切除术后乳房重建的决策辅助。BREASTChoice的独特功能包括1)使用EHR的临床数据进行个性化风险预测，2)面向临床和患者的组件，3)交互式格式。将决策辅助与面向患者和临床医生的组件以及交互式部分集成在一起会带来独特的部署问题。根据这些经验,我们概述了5项关键实施建议：1)让所有相关利益相关者参与进来，包括患者,临床医生,和信息学专家；2）明确并不断地绘制所有人员和流程；3）积极寻求相关的机构政策和程序；4）计划整合需要比开发独立决策辅助或具有静态组件的决策辅助系统更长的时间；5）将有关软件编程的知识从一个机构转移到另一个机构，但期望本地和特定于环境的变化。将患者决策辅助工具集成到EHR中是可行且可扩展的，但需要为特定挑战做好准备，并以灵活的心态专注于实施。
UNASSIGNED：将面向患者和临床医生的组件的交互式决策辅助工具集成到电子健康记录中可以促进共享决策，但存在独特的实施挑战。我们成功地将乳房切除术后乳房重建的决策辅助工具BREASTChoice集成到电子健康记录中。根据这些经验,我们提供这些实施建议：1)让相关利益相关者参与，2)明确和持续地绘制人员和过程，3)寻求体制政策和程序，4）计划比独立的决策辅助需要更长的时间，和5）将软件编程从一个站点转移到另一个站点，但期望本地更改。
UNASSIGNED：将面向患者和临床医生的组件的交互式决策辅助工具集成到电子健康记录中可以促进共享决策，但存在独特的实施挑战。我们成功地将乳房切除术后乳房重建的决策辅助工具BREASTChoice集成到电子健康记录中。根据这些经验,我们提供这些实施建议：1)让相关利益相关者参与，2)明确和持续地绘制人员和过程，3)寻求体制政策和程序，4）计划比独立的决策辅助需要更长的时间，和5）将软件编程从一个站点转移到另一个站点，但期望本地更改。
