PDF(Pubmed)
Abstract：
OBJECTIVE: To use workflow execution models to highlight new considerations for patient-centered clinical decision support policies (PC CDS), processes, procedures, technology, and expertise required to support new workflows.
METHODS: To generate and refine models, we used (1) targeted literature reviews; (2) key informant interviews with 6 external PC CDS experts; (3) model refinement based on authors\' experience; and (4) validation of the models by a 26-member steering committee.
CONCLUSIONS: We identified 7 major issues that provide significant challenges and opportunities for healthcare systems, researchers, administrators, and health IT and app developers. Overcoming these challenges presents opportunities for new or modified policies, processes, procedures, technology, and expertise to: (1) Ensure patient-generated health data (PGHD), including patient-reported outcomes (PROs), are documented, reviewed, and managed by appropriately trained clinicians, between visits and after regular working hours. (2) Educate patients to use connected medical devices and handle technical issues. (3) Facilitate collection and incorporation of PGHD, PROs, patient preferences, and social determinants of health into existing electronic health records. (4) Troubleshoot erroneous data received from devices. (5) Develop dashboards to display longitudinal patient-reported data. (6) Provide reimbursement to support new models of care. (7) Support patient engagement with remote devices.
CONCLUSIONS: Several new policies, processes, technologies, and expertise are required to ensure safe and effective implementation and use of PC CDS. As we gain more experience implementing and working with PC CDS, we should be able to begin realizing the long-term positive impact on patient health that the patient-centered movement in healthcare promises.
METHODS: To generate and refine models, we used (1) targeted literature reviews; (2) key informant interviews with 6 external PC CDS experts; (3) model refinement based on authors\' experience; and (4) validation of the models by a 26-member steering committee.
CONCLUSIONS: We identified 7 major issues that provide significant challenges and opportunities for healthcare systems, researchers, administrators, and health IT and app developers. Overcoming these challenges presents opportunities for new or modified policies, processes, procedures, technology, and expertise to: (1) Ensure patient-generated health data (PGHD), including patient-reported outcomes (PROs), are documented, reviewed, and managed by appropriately trained clinicians, between visits and after regular working hours. (2) Educate patients to use connected medical devices and handle technical issues. (3) Facilitate collection and incorporation of PGHD, PROs, patient preferences, and social determinants of health into existing electronic health records. (4) Troubleshoot erroneous data received from devices. (5) Develop dashboards to display longitudinal patient-reported data. (6) Provide reimbursement to support new models of care. (7) Support patient engagement with remote devices.
CONCLUSIONS: Several new policies, processes, technologies, and expertise are required to ensure safe and effective implementation and use of PC CDS. As we gain more experience implementing and working with PC CDS, we should be able to begin realizing the long-term positive impact on patient health that the patient-centered movement in healthcare promises.
摘要：
目标：使用工作流执行模型来突出以患者为中心的临床决策支持策略(PCCDS)的新考虑因素，进程,程序,技术,以及支持新工作流所需的专业知识。
方法：要生成和完善模型，我们使用(1)有针对性的文献综述;(2)与6名外部PCCDS专家进行的关键信息访谈;(3)基于作者经验的模型改进;(4)由26名成员组成的指导委员会对模型进行验证.
结论：我们确定了7个主要问题，这些问题为医疗保健系统带来了重大挑战和机遇，研究人员,管理员,以及健康的IT和应用程序开发人员。克服这些挑战为新的或修改的政策提供了机会，进程,程序,技术,和专业知识：(1)确保患者生成的健康数据(PGHD)，包括患者报告的结果(PRO)，被记录在案，reviewed,并由训练有素的临床医生管理，在访问之间和正常工作时间之后。（2）教育患者使用连接的医疗器械，处理技术问题。(3)促进PGHD的收集和合并，PROs,患者偏好,并将健康的社会决定因素纳入现有的电子健康记录。(4)对从设备接收到的错误数据进行故障排除。(5)开发显示纵向患者报告数据的仪表板。（6）提供报销以支持新的护理模式。(7)支持患者参与远程设备。
结论：几项新政策，进程,技术,和专业知识需要确保PCCDS的安全和有效实施和使用。随着我们获得更多实施和使用PCCDS的经验，我们应该能够开始意识到医疗保健中以患者为中心的运动对患者健康的长期积极影响。
方法：要生成和完善模型，我们使用(1)有针对性的文献综述;(2)与6名外部PCCDS专家进行的关键信息访谈;(3)基于作者经验的模型改进;(4)由26名成员组成的指导委员会对模型进行验证.
结论：我们确定了7个主要问题，这些问题为医疗保健系统带来了重大挑战和机遇，研究人员,管理员,以及健康的IT和应用程序开发人员。克服这些挑战为新的或修改的政策提供了机会，进程,程序,技术,和专业知识：(1)确保患者生成的健康数据(PGHD)，包括患者报告的结果(PRO)，被记录在案，reviewed,并由训练有素的临床医生管理，在访问之间和正常工作时间之后。（2）教育患者使用连接的医疗器械，处理技术问题。(3)促进PGHD的收集和合并，PROs,患者偏好,并将健康的社会决定因素纳入现有的电子健康记录。(4)对从设备接收到的错误数据进行故障排除。(5)开发显示纵向患者报告数据的仪表板。（6）提供报销以支持新的护理模式。(7)支持患者参与远程设备。
结论：几项新政策，进程,技术,和专业知识需要确保PCCDS的安全和有效实施和使用。随着我们获得更多实施和使用PCCDS的经验，我们应该能够开始意识到医疗保健中以患者为中心的运动对患者健康的长期积极影响。
