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Article ; Online: Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities.

Karimi, Madjid / Dhopeshwarkar, Rina / Jiménez, Frances / Ryan, Sofia / Plourde, Emma

American journal on intellectual and developmental disabilities

2024 Volume 129, Issue 3, Page(s) 231–241

Abstract: Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into ... ...

Abstract	Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.
MeSH term(s)	Humans ; Developmental Disabilities/therapy ; Intellectual Disability/therapy ; Patient Outcome Assessment ; United States ; Patient-Centered Care/standards
Language	English
Publishing date	2024-04-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2477909-X
ISSN	1944-7558 ; 1944-7515
ISSN (online)	1944-7558
ISSN	1944-7515
DOI	10.1352/1944-7558-129.3.231
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Article ; Online: Patient-Centered Clinical Decision Support-Where Are We and Where to Next?

Dullabh, Prashila / Leaphart, Desirae / Dhopeshwarkar, Rina / Heaney-Huls, Krysta / Desai, Priyanka

Studies in health technology and informatics

2024 Volume 310, Page(s) 444–448

Abstract: Patient-centered clinical decision support (PC CDS) includes digital health tools that support patients, caregivers, and care teams in healthcare decisions that incorporate patient-centered factors related to four components: knowledge, data, delivery, ... ...

Abstract	Patient-centered clinical decision support (PC CDS) includes digital health tools that support patients, caregivers, and care teams in healthcare decisions that incorporate patient-centered factors related to four components: knowledge, data, delivery, and use. This paper explores the current state of each factor and how each promotes patient-centeredness in healthcare. We conducted a literature review, reviewing 175 peer-reviewed and grey literature, and eighteen key informant interviews. Findings show a need for more research on how to incorporate patient input into the guideline selection and prioritization for PC CDS, development and implementation of PC CDS tools, technical challenges for capturing patient contributed data, and optimizing PC CDS across various settings to meet patient and caregiver needs. While progress is being made in each of the four components of PC CDS, critical gaps remain.
MeSH term(s)	Humans ; Decision Support Systems, Clinical ; Digital Health ; Expert Systems ; Health Facilities ; Patient-Centered Care
Language	English
Publishing date	2024-01-25
Publishing country	Netherlands
Document type	Review ; Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI231004
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Article ; Online: A lifecycle framework illustrates eight stages necessary for realizing the benefits of patient-centered clinical decision support.

Sittig, Dean F / Boxwala, Aziz / Wright, Adam / Zott, Courtney / Desai, Priyanka / Dhopeshwarkar, Rina / Swiger, James / Lomotan, Edwin A / Dobes, Angela / Dullabh, Prashila

Journal of the American Medical Informatics Association : JAMIA

2023 Volume 30, Issue 9, Page(s) 1583–1589

Abstract: The design, development, implementation, use, and evaluation of high-quality, patient-centered clinical decision support (PC CDS) is necessary if we are to achieve the quintuple aim in healthcare. We developed a PC CDS lifecycle framework to promote a ... ...

Abstract	The design, development, implementation, use, and evaluation of high-quality, patient-centered clinical decision support (PC CDS) is necessary if we are to achieve the quintuple aim in healthcare. We developed a PC CDS lifecycle framework to promote a common understanding and language for communication among researchers, patients, clinicians, and policymakers. The framework puts the patient, and/or their caregiver at the center and illustrates how they are involved in all the following stages: Computable Clinical Knowledge, Patient-specific Inference, Information Delivery, Clinical Decision, Patient Behaviors, Health Outcomes, Aggregate Data, and patient-centered outcomes research (PCOR) Evidence. Using this idealized framework reminds key stakeholders that developing, deploying, and evaluating PC-CDS is a complex, sociotechnical challenge that requires consideration of all 8 stages. In addition, we need to ensure that patients, their caregivers, and the clinicians caring for them are explicitly involved at each stage to help us achieve the quintuple aim.
MeSH term(s)	Humans ; Decision Support Systems, Clinical ; Delivery of Health Care ; Communication ; Patients ; Patient-Centered Care
Language	English
Publishing date	2023-07-04
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocad122
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Article ; Online: Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support.

Dhopeshwarkar, Rina V / Freij, Maysoun / Callaham, Melissa / Desai, Priyanka J / I Harrison, Michael / Swiger, James / A Lomotan, Edwin / Dymek, Chris / Dullabh, Prashila

Applied clinical informatics

2023 Volume 14, Issue 3, Page(s) 566–574

Abstract: Background: Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly ... ...

Abstract	Background: Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly available CDS that uses standards to express clinical logic (i.e., standards-based CDS) has the potential to reduce duplicative efforts of translating the same clinical evidence into CDS across multiple health care institutions. Yet development of such CDS is relatively new and its potential only partially explored. Objectives: This study aimed to describe lessons learned from a national initiative promoting publicly available, standards-based CDS resources, discuss challenges, and report suggestions for improvement. Methods: Findings were drawn from an evaluation of the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research CDS Initiative, which aimed to advance evidence into practice through standards-based and publicly available CDS. Methods included literature and program material reviews, key informant interviews, and a web-based survey about a public repository of CDS artifacts and tools for authoring standards-based CDS. Results: The evaluation identified important lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. Trust is a critical factor in uptake and can be bolstered through transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous improvement. Additionally, while adoption of standards among electronic health record developers will make it easier to implement standards-based CDS, lower-resourced health systems will need extra support to ensure successful implementation and use. Finally, although we found the resources developed by the Initiative to offer valuable prototypes for the field, health systems desire more information about patient-centered, clinical, and cost-related outcomes to help them justify the investment required to implement standards-based, publicly available CDS. Conclusion: While the standards and technology to publicly share standards-based CDS have increased, broad dissemination and implementation remain challenging.
MeSH term(s)	Humans ; Decision Support Systems, Clinical ; Delivery of Health Care ; Clinical Decision-Making ; Electronic Health Records ; Medical Errors
Language	English
Publishing date	2023-07-26
Publishing country	Germany
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0043-1769911
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Article: Incorporating Social Determinants of Health in Electronic Health Records: Qualitative Study of Current Practices Among Top Vendors.

Freij, Maysoun / Dullabh, Prashila / Lewis, Sarah / Smith, Scott R / Hovey, Lauren / Dhopeshwarkar, Rina

JMIR medical informatics

2019 Volume 7, Issue 2, Page(s) e13849

Abstract: Background: Social determinants of health (SDH) are increasingly seen as important to understanding patient health and identifying appropriate interventions to improve health outcomes in what is a complex interplay between health system-, community-, ... ...

Abstract	Background: Social determinants of health (SDH) are increasingly seen as important to understanding patient health and identifying appropriate interventions to improve health outcomes in what is a complex interplay between health system-, community-, and individual-level factors. Objective: The objective of the paper was to investigate the development of electronic health record (EHR) software products that allow health care providers to identify and address patients' SDH in health care settings. Methods: We conducted interviews with six EHR vendors with large market shares in both ambulatory and inpatient settings. We conducted thematic analysis of the interviews to (1) identify their motivations to develop such software products, (2) describe their products and uses, and (3) identify facilitators and challenges to collection and use of SDH data-through their products or otherwise-either at the point of care or in population health interventions. Results: Our findings indicate that vendor systems and their functionalities are influenced by client demand and initiative, federal initiatives, and the vendors' strategic vision about opportunities in the health care system. Among the small sample of vendors with large market shares, SDH is a new area for growth, and the vendors range in the number and sophistication of their SDH-related products. To enable better data analytics, population health management, and interoperability of SDH data, vendors recognized the need for more standardization of SDH performance measures across various federal and state programs, better mapping of SDH measures to multiple types of codes, and development of more codes for all SDH measures of interest. Conclusions: Vendors indicate they are actively developing products to facilitate the collection and use of SDH data for their clients and are seeking solutions to data standardization and interoperability challenges through internal product decisions and collaboration with policymakers. Due to a lack of policy standards around SDH data, product-specific decisions may end up being de facto policies given the market shares of particular vendors. However, commercial vendors appear ready to collaboratively discuss policy solutions such as standards or guidelines with each other, health care systems, and government agencies in order to further promote integration of SDH data into the standard of care for all health systems.
Language	English
Publishing date	2019-06-07
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2798261-0
ISSN	2291-9694
ISSN	2291-9694
DOI	10.2196/13849
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Article: Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support

Dhopeshwarkar, Rina V. / Freij, Maysoun / Callaham, Melissa / Desai, Priyanka J. / I. Harrison, Michael / Swiger, James / A. Lomotan, Edwin / Dymek, Chris / Dullabh, Prashila

Applied Clinical Informatics

2023 Volume 14, Issue 03, Page(s) 566–574

Abstract	Background: Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly available CDS that uses standards to express clinical logic (i.e., standards-based CDS) has the potential to reduce duplicative efforts of translating the same clinical evidence into CDS across multiple health care institutions. Yet development of such CDS is relatively new and its potential only partially explored. Objectives: This study aimed to describe lessons learned from a national initiative promoting publicly available, standards-based CDS resources, discuss challenges, and report suggestions for improvement. Methods: Findings were drawn from an evaluation of the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research CDS Initiative, which aimed to advance evidence into practice through standards-based and publicly available CDS. Methods included literature and program material reviews, key informant interviews, and a web-based survey about a public repository of CDS artifacts and tools for authoring standards-based CDS. Results: The evaluation identified important lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. Trust is a critical factor in uptake and can be bolstered through transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous improvement. Additionally, while adoption of standards among electronic health record developers will make it easier to implement standards-based CDS, lower-resourced health systems will need extra support to ensure successful implementation and use. Finally, although we found the resources developed by the Initiative to offer valuable prototypes for the field, health systems desire more information about patient-centered, clinical, and cost-related outcomes to help them justify the investment required to implement standards-based, publicly available CDS. Conclusion: While the standards and technology to publicly share standards-based CDS have increased, broad dissemination and implementation remain challenging.
Keywords	decision support systems ; electronic health records ; standards-based CDS ; implementation ; facilitators and barriers
Language	English
Publishing date	2023-05-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0043-1769911
Database	Thieme publisher's database

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Article ; Online: Patient experience over time in patient-centered medical homes.

Kern, Lisa M / Dhopeshwarkar, Rina V / Edwards, Alison / Kaushal, Rainu

The American journal of managed care

2013 Volume 19, Issue 5, Page(s) 403–410

Abstract: Objectives: Although the Patient-Centered Medical Home (PCMH) model is being implemented across the country to transform primary care, it is not yet clear whether this model actually improves patients' experiences with healthcare. Our objective was to ... ...

Abstract	Objectives: Although the Patient-Centered Medical Home (PCMH) model is being implemented across the country to transform primary care, it is not yet clear whether this model actually improves patients' experiences with healthcare. Our objective was to measure patients' experiences over time in practices that transformed into PCMHs. Study design: We conducted a prospective study, using 2 serial cross-sectional samples, in a multipayer community. Methods: We surveyed 715 patients: 346 at baseline, when practices had just completed transformation, and 369 at follow-up, which was a median of 15 months later. These patients received care from 120 primary care providers at 10 ambulatory practices (20 sites) that achieved Level III PCMH, as defined by the National Committee for Quality Assurance. We measured patient experience, as defined by the 7 domains of the Clinician and Group-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Adult Primary Care Questionnaire. Results: Patients' self-reported experience with access to care improved significantly over time, with 61% of respondents giving access to care the highest rating at baseline versus 69% at follow-up (P = .02). There were no significant changes over time for the other domains. Conclusions: The PCMH was associated with improvements in patients' experience with access to care but not other domains of care. This study, which took place in a multi-payer community, is one of the first to find a positive effect of the PCMH on patient experience.
MeSH term(s)	Female ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Patient-Centered Care ; Prospective Studies ; United States
Language	English
Publishing date	2013-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
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Article ; Online: User experiences with pharmacy benefit manager data at the point of care.

Kaushal, Rainu / Dhopeshwarkar, Rina / Gottlieb, Lawrence / Jordan, Harmon

Journal of evaluation in clinical practice

2010 Volume 16, Issue 6, Page(s) 1076–1080

Abstract: Objective: MedsInfo-ED is a model health information exchange project for a network of emergency departments (EDs) in the state of Massachusetts. In this initiative, claims data from pharmacy benefit managers (PBMs) were made available at the point of ... ...

Abstract	Objective: MedsInfo-ED is a model health information exchange project for a network of emergency departments (EDs) in the state of Massachusetts. In this initiative, claims data from pharmacy benefit managers (PBMs) were made available at the point of care to clinicians in the EDs. We performed a qualitative assessment of respondents' experiences with MedsInfo-ED. Methods: The assessment occurred at three pilot site EDs after implementation of MedsInfo-ED. A semi-structured interview instrument was used to collect information on strengths and weaknesses of the intervention. Results: Respondents generally felt that MedsInfo-ED improved their knowledge of patients' medications. However, overall, the respondents did not believe that MedsInfo-ED decreased the time required to obtain a medication list. Workflow integration of the application differed among the three hospital sites in order to best fit their department needs. Important additional information desired by the respondents included psychiatric and HIV medications, mail order medications and medications dispensed in other countries. Suggestions for improvement included integrating the patient consent process into the workflow as well as improving medication list outputs. Conclusions: The integration of PBM data at the point of care may help improve access to and completeness of patient medication histories, although such systems need to be carefully designed and implemented.
MeSH term(s)	Automation ; Emergency Service, Hospital ; Humans ; Insurance Claim Reporting ; Insurance, Pharmaceutical Services ; Interviews as Topic ; Massachusetts ; Point-of-Care Systems
Language	English
Publishing date	2010-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1327355-3
ISSN	1365-2753 ; 1356-1294
ISSN (online)	1365-2753
ISSN	1356-1294
DOI	10.1111/j.1365-2753.2009.01255.x
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Article ; Online: Which components of health information technology will drive financial value?

Kern, Lisa M / Wilcox, Adam / Shapiro, Jason / Dhopeshwarkar, Rina V / Kaushal, Rainu

The American journal of managed care

2012 Volume 18, Issue 8, Page(s) 438–445

Abstract: Objectives: The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most ... ...

Abstract	Objectives: The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most likely to drive financial savings in the ambulatory, inpatient, and emergency department settings. Study design: Framework development and a national expert panel. Methods: We searched the literature to identify functionalities enabled by EHRs and HIE across the 3 healthcare settings. We rated each of 233 functionality-setting combinations on their likelihood of having a positive financial effect. We validated the top-scoring functionalities with a panel of 28 national experts, and we compared the high-scoring functionalities with Stage 1 meaningful use criteria. Results: We identified 54 high-scoring functionality- setting combinations, 27 for EHRs and 27 for HIE. Examples of high-scoring functionalities included providing alerts for expensive medications, providing alerts for redundant lab orders, sending and receiving imaging reports, and enabling structured medication reconciliation. Of the 54 high-scoring functionalities, 25 (46%) are represented in Stage 1 meaningful use. Many of the functionalities not yet represented in meaningful use correspond with functionalities that focus directly on healthcare utilization and costs rather than on healthcare quality per se. Conclusions: This work can inform the development and selection of future meaningful use measures; inform implementation efforts, as clinicians and hospitals choose from among a "menu" of measures for meaningful use; and inform evaluation efforts, as investigators seek to measure the actual financial impact of EHRs and HIE.
MeSH term(s)	Cost Savings ; Electronic Health Records/economics ; Health Information Systems/economics ; Meaningful Use ; Medical Informatics/economics ; Medical Record Linkage ; United States
Language	English
Publishing date	2012-08-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
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Article ; Online: Health care consumers' preferences around health information exchange.

Dhopeshwarkar, Rina V / Kern, Lisa M / O'Donnell, Heather C / Edwards, Alison M / Kaushal, Rainu

Annals of family medicine

2012 Volume 10, Issue 5, Page(s) 428–434

Abstract: PURPOSE Consumer buy-in is important for the success of widespread federal initiatives to promote the use of health information exchange (HIE). Little is known, however, of consumers' preferences around the storing and sharing of electronic health ... ...

Abstract	PURPOSE Consumer buy-in is important for the success of widespread federal initiatives to promote the use of health information exchange (HIE). Little is known, however, of consumers' preferences around the storing and sharing of electronic health information. We conducted a study to better understand consumer preferences regarding the privacy and security of HIE. METHODS In 2008 we conducted a cross-sectional, random digit dial telephone survey of residents in the Hudson Valley of New York State, a state where patients must affirmatively consent to having their data accessed through HIE. RESULTS There was an 85% response rate (N = 170) for the survey. Most consumers would prefer that permission be obtained before various parties, including their clinician, could view their health information through HIE. Most consumers wanted any method of sharing their health information to have safeguards in place to protect against unauthorized viewing (86%). They also wanted to be able to see who has viewed their information (86%), to stop electronic storage of their data (84%), to stop all viewing (83%), and to select which parts of their health information are shared (78%). Among the approximately one-third (n = 54) of consumers who were uncomfortable with automatic inclusion of their health information in an electronic database for HIE, 78% wished to approve all information explicitly, and most preferred restricting information by clinician (83%), visit (81%), or information type (88%). CONCLUSION Consumers in a state with an opt-in consent policy are interested in having greater control over the privacy and security of their electronic health information. These preferences should be considered when developing and implementing systems, standards and policies.
MeSH term(s)	Adolescent ; Adult ; Aged ; Confidentiality ; Cross-Sectional Studies ; Disclosure ; Electronic Health Records ; Female ; Health Information Systems ; Humans ; Informed Consent/statistics & numerical data ; Male ; Middle Aged ; Patient Preference/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2012-09-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171425-3
ISSN	1544-1717 ; 1544-1709
ISSN (online)	1544-1717
ISSN	1544-1709
DOI	10.1370/afm.1396
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