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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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Visualization of Patient-Generated Health Data: A Scoping Review of Dashboard Designs.

Shenvi, Edna / Boxwala, Aziz / Sittig, Dean / Zott, Courtney / Lomotan, Edwin / Swiger, James / Dullabh, Prashila

Applied clinical informatics

2023 Volume 14, Issue 5, Page(s) 913–922

Abstract: Background: Patient-centered clinical decision support (PC CDS) aims to assist with tailoring decisions to an individual patient's needs. Patient-generated health data (PGHD), including physiologic measurements captured frequently by automated devices, ... ...

Abstract	Background: Patient-centered clinical decision support (PC CDS) aims to assist with tailoring decisions to an individual patient's needs. Patient-generated health data (PGHD), including physiologic measurements captured frequently by automated devices, provide important information for PC CDS. The volume and availability of such PGHD is increasing, but how PGHD should be presented to clinicians to best aid decision-making is unclear. Objectives: Identify best practices in visualizations of physiologic PGHD, for designing a software application as a PC CDS tool. Methods: We performed a scoping review of studies of PGHD dashboards that involved clinician users in design or evaluations. We included only studies that used physiologic PGHD from single patients for usage in decision-making. Results: We screened 468 titles and abstracts, 63 full-text papers, and identified 15 articles to include in our review. Some research primarily sought user input on PGHD presentation; other studies garnered feedback only as a side effort for other objectives (e.g., integration with electronic health records [EHRs]). Development efforts were often in the domains of chronic diseases and collected a mix of physiologic parameters (e.g., blood pressure and heart rate) and activity data. Users' preferences were for data to be presented with statistical summaries and clinical interpretations, alongside other non-PGHD data. Recurrent themes indicated that users desire longitudinal data display, aggregation of multiple data types on the same screen, actionability, and customization. Speed, simplicity, and availability of data for other purposes (e.g., documentation) were key to dashboard adoption. Evaluations were favorable for visualizations using common graphing or table formats, although best practices for implementation have not yet been established. Conclusion: Although the literature identified common themes on data display, measures, and usability, more research is needed as PGHD usage grows. Ensuring that care is tailored to individual needs will be important in future development of clinical decision support.
MeSH term(s)	Humans ; Electronic Health Records ; Software ; Surveys and Questionnaires ; Text Messaging
Language	English
Publishing date	2023-09-13
Publishing country	Germany
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/a-2174-7820
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Medicare Data Linkages for Conducting Patient-Centered Outcomes Research on Economic Outcomes.

Brown, Derek S / Srinivasan, Mithuna / Zott, Courtney / Wilson, Kala / Dullabh, Prashila / Smith, Scott R

Medical care

2023 Volume 61, Issue 12 Suppl 2, Page(s) S122–S130

Abstract: Background: Medicare patients and other stakeholders often make health care decisions that have economic consequences. Research on economic variables that patients have identified as important is referred to as patient-centered outcomes research (PCOR) ... ...

Abstract	Background: Medicare patients and other stakeholders often make health care decisions that have economic consequences. Research on economic variables that patients have identified as important is referred to as patient-centered outcomes research (PCOR) and can generate evidence that informs decision-making. Medicare fee-for-service (FFS) claims are widely used for research and are a potentially valuable resource for studying some economic variables, particularly when linked to other datasets. Objective: The aim of this study was to identify and assess the characteristics of federally funded administrative and survey data sources that can be linked to Medicare claims for conducting PCOR on some economic outcomes. Research design: A targeted internet search was conducted to identify a list of relevant data sources. A technical panel and key informant interviews were used for guidance and feedback. Results: We identified 12 survey and 6 administrative sources of linked data for Medicare FFS beneficiaries. A majority provide longitudinal data and are updated annually. All linked sources provide some data on social determinants of health and health equity-related factors. Fifteen sources capture direct medical costs (beyond Medicare FFS payments); 5 capture indirect costs (eg, lost wages from absenteeism), and 7 capture direct nonmedical costs (eg, transportation). Conclusions: Linking Medicare FFS claims data to other federally funded data sources can facilitate research on some economic outcomes for PCOR. However, few sources capture direct nonmedical or indirect costs. Expanding linkages to include additional data sources, and reducing barriers to existing data sources, remain important objectives for increasing high-quality, patient-centered economic research.
MeSH term(s)	Aged ; Humans ; United States ; Medicare ; Costs and Cost Analysis ; Fee-for-Service Plans ; Information Storage and Retrieval
Language	English
Publishing date	2023-11-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001896
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Article ; Online: Federal Data for Conducting Patient-centered Outcomes Research on Economic Outcomes.

Brown, Derek S / Srinivasan, Mithuna / Arbulu, Lucas / Dullabh, Prashila / Curtis, Kamisha / Zott, Courney / Smith, Scott R

Medical care

2023 Volume 61, Issue 7, Page(s) 462–469

Abstract: Background: Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient- ... ...

Abstract	Background: Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient-centered outcomes research (PCOR), an assessment of the coverage and gaps in federally funded data for PCOR economic evaluations has not been produced to date. Objectives: To classify relevant categories of PCOR economic costs, to assess current federally funded data for coverage of these categories, and to identify gaps for future research and collection. Research design: A targeted internet search was conducted to identify a list of relevant outcomes and data sources. The study team assessed data sources for coverage of economic outcomes. A technical panel and key informant interviews were used for evaluation and feedback. Results: Four types of formal health care sector costs, 3 types of informal health care sector costs, and 10 types of non-health care sector costs were identified as relevant for PCOR economic evaluations. Twenty-nine federally funded data sources were identified. Most contained elements on formal costs. Data on informal costs (eg, transportation) were less common, and non-health care sector costs (eg, productivity) were the least common. Most data sources were annual, cross-sectional, nationally representative individual-level surveys. Conclusions: The existing federal data infrastructure captures many areas of the economic burden of health and health care, but gaps remain. Research from multiple data sources and potential future integrations may offset gaps in individual data sources. Linkages are promising strategies for future research on patient-centered economic outcomes.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Patient Outcome Assessment ; Delivery of Health Care ; Caregivers ; Outcome Assessment, Health Care
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001862
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Article: Visualization of Patient-Generated Health Data: A Scoping Review of Dashboard Designs

Shenvi, Edna / Boxwala, Aziz / Sittig, Dean / Zott, Courtney / Lomotan, Edwin / Swiger, James / Dullabh, Prashila

Applied Clinical Informatics

2023 Volume 14, Issue 05, Page(s) 913–922

Abstract	Background: Patient-centered clinical decision support (PC CDS) aims to assist with tailoring decisions to an individual patient's needs. Patient-generated health data (PGHD), including physiologic measurements captured frequently by automated devices, provide important information for PC CDS. The volume and availability of such PGHD is increasing, but how PGHD should be presented to clinicians to best aid decision-making is unclear. Objectives: Identify best practices in visualizations of physiologic PGHD, for designing a software application as a PC CDS tool. Methods: We performed a scoping review of studies of PGHD dashboards that involved clinician users in design or evaluations. We included only studies that used physiologic PGHD from single patients for usage in decision-making. Results: We screened 468 titles and abstracts, 63 full-text papers, and identified 15 articles to include in our review. Some research primarily sought user input on PGHD presentation; other studies garnered feedback only as a side effort for other objectives (e.g., integration with electronic health records [EHRs]). Development efforts were often in the domains of chronic diseases and collected a mix of physiologic parameters (e.g., blood pressure and heart rate) and activity data. Users' preferences were for data to be presented with statistical summaries and clinical interpretations, alongside other non-PGHD data. Recurrent themes indicated that users desire longitudinal data display, aggregation of multiple data types on the same screen, actionability, and customization. Speed, simplicity, and availability of data for other purposes (e.g., documentation) were key to dashboard adoption. Evaluations were favorable for visualizations using common graphing or table formats, although best practices for implementation have not yet been established. Conclusion: Although the literature identified common themes on data display, measures, and usability, more research is needed as PGHD usage grows. Ensuring that care is tailored to individual needs will be important in future development of clinical decision support.
Keywords	clinical decision support ; patient-centered care ; shared decision-making ; patient-generated health data ; other clinical informatics applications ; patient engagement
Language	English
Publishing date	2023-09-13
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/a-2174-7820
Database	Thieme publisher's database

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Article ; Online: The Technology Landscape of Patient-Centered Clinical Decision Support - Where Are We and What Is Needed?

Dullabh, Prashila / Heaney-Huls, Krysta / Hovey, Lauren / Sandberg, Shana / Lobach, David F / Boxwala, Aziz / Desai, Priyanka / Sittig, Dean F

Studies in health technology and informatics

2022 Volume 290, Page(s) 350–353

Abstract: Patient Centered Outcomes Research (PCOR) and health care delivery system transformation require investments in development of tools and techniques for rapid dissemination of clinical and operational best practices. This paper explores the current ... ...

Abstract	Patient Centered Outcomes Research (PCOR) and health care delivery system transformation require investments in development of tools and techniques for rapid dissemination of clinical and operational best practices. This paper explores the current technology landscape for patient-centered clinical decision support (PC CDS) and what is needed to make it more shareable, standards-based, and publicly available with the goal of improving patient care and clinical outcomes. The landscape assessment used three sources of information: (1) a 22-member technical expert panel; (2) a literature review of peer-reviewed and grey literature; and (3) key informant interviews with PC CDS stakeholders. We identified ten salient technical considerations that span all phases of PC CDS development; our findings suggest there has been significant progress in the development and implementation of PC CDS but challenges remain.
MeSH term(s)	Decision Support Systems, Clinical ; Delivery of Health Care ; Humans ; Patient Outcome Assessment ; Patient-Centered Care ; Technology
Language	English
Publishing date	2022-06-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI220094
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Application Programming Interfaces in Health Care: Findings from a Current-State Sociotechnical Assessment.

Dullabh, Prashila / Hovey, Lauren / Heaney-Huls, Krysta / Rajendran, Nithya / Wright, Adam / Sittig, Dean F

Applied clinical informatics

2020 Volume 11, Issue 1, Page(s) 59–69

Abstract: Objective: Interest in application programming interfaces (APIs) is increasing as key stakeholders look for technical solutions to interoperability challenges. We explored three thematic areas to assess the current state of API use for data access and ... ...

Abstract	Objective: Interest in application programming interfaces (APIs) is increasing as key stakeholders look for technical solutions to interoperability challenges. We explored three thematic areas to assess the current state of API use for data access and exchange in health care: (1) API use cases and standards; (2) challenges and facilitators for read and write capabilities; and (3) outlook for development of write capabilities. Methods: We employed four methods: (1) literature review; (2) expert interviews with 13 API stakeholders; (3) review of electronic health record (EHR) app galleries; and (4) a technical expert panel. We used an eight-dimension sociotechnical model to organize our findings. Results: The API ecosystem is complicated and cuts across five of the eight sociotechnical model dimensions: (1) app marketplaces support a range of use cases, the majority of which target providers' needs, with far fewer supporting patient access to data; (2) current focus on read APIs with limited use of write APIs; (3) where standards are used, they are largely Fast Healthcare Interoperability Resources (FHIR); (4) FHIR-based APIs support exchange of electronic health information within the common clinical data set; and (5) validating external data and data sources for clinical decision making creates challenges to provider workflows. Conclusion: While the use of APIs in health care is increasing rapidly, it is still in the pilot stages. We identified five key issues with implications for the continued advancement of API use: (1) a robust normative FHIR standard; (2) expansion of the common clinical data set to other data elements; (3) enhanced support for write implementation; (4) data provenance rules; and (5) data governance rules. Thus, while APIs are being touted as a solution to interoperability challenges, they remain an emerging technology that is only one piece of a multipronged approach to data access and use.
MeSH term(s)	Communication ; Delivery of Health Care ; Health Information Exchange ; Humans ; Software ; Workflow
Language	English
Publishing date	2020-01-22
Publishing country	Germany
Document type	Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0039-1701001
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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 ; Online: Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.

Dullabh, Prashila / Heaney-Huls, Krysta K / Chiao, Andrew B / Callaham, Melissa G / Desai, Priyanka / Gauthreaux, Nicole A / Kashyap, Nitu / Lobach, David F / Boxwala, Aziz

JAMIA open

2023 Volume 6, Issue 4, Page(s) ooad098

Abstract: Remote monitoring of women experiencing hypertensive disorders of pregnancy (HDP) can provide timely life-saving data, particularly if these data are integrated into existing patient and clinical workflows. This pilot intervention of a smartphone ... ...

Abstract	Remote monitoring of women experiencing hypertensive disorders of pregnancy (HDP) can provide timely life-saving data, particularly if these data are integrated into existing patient and clinical workflows. This pilot intervention of a smartphone application (app) for postpartum monitoring of hypertensive disorders integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the evaluation of the pilot highlight the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. The implementation team's key observations included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
Language	English
Publishing date	2023-11-14
Publishing country	United States
Document type	Case Reports
ISSN	2574-2531
ISSN (online)	2574-2531
DOI	10.1093/jamiaopen/ooad098
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