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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: 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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Potential Uses of Blockchain Technology for Outcomes Research on Opioids.

Gonzales, Aldren / Smith, Scott R / Dullabh, Prashila / Hovey, Lauren / Heaney-Huls, Krysta / Robichaud, Meagan / Boodoo, Roger

JMIR medical informatics

2021 Volume 9, Issue 8, Page(s) e16293

Abstract: The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, ... ...

Abstract	The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined.
Language	English
Publishing date	2021-08-27
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2798261-0
ISSN	2291-9694
ISSN	2291-9694
DOI	10.2196/16293
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Article ; Online: Application Programming Interfaces (APIs) in Health Care: Findings from a Current-State Assessment.

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

Studies in health technology and informatics

2019 Volume 265, Page(s) 201–206

Abstract: Interest in application programming interfaces (APIs) as a means to increase health data access and exchange among patients, health care providers, and payers has become an important area for development. In an effort to better understand the various ... ...

Abstract	Interest in application programming interfaces (APIs) as a means to increase health data access and exchange among patients, health care providers, and payers has become an important area for development. In an effort to better understand the various contexts in which APIs can be applied, we explored different use cases. While APIs and our collective understanding of the best ways to implement and use them continue to develop, in the coming years the use of proprietary and standards-based APIs could be key to the sustainability of applied clinical informatics research, as well as associated improvements in patient engagement, clinical decision making, efficiency, quality and safety of the healthcare delivery system.
MeSH term(s)	Clinical Decision-Making ; Humans ; Medical Informatics ; Patient Participation ; Software
Language	English
Publishing date	2019-09-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI190164
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Article ; Online: Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.

Dullabh, Prashila / Sandberg, Shana F / Heaney-Huls, Krysta / Hovey, Lauren S / Lobach, David F / Boxwala, Aziz / Desai, Priyanka J / Berliner, Elise / Dymek, Chris / Harrison, Michael I / Swiger, James / Sittig, Dean F

Journal of the American Medical Informatics Association : JAMIA

2022 Volume 29, Issue 7, Page(s) 1233–1243

Abstract: Objective: We conducted a horizon scan to (1) identify challenges in patient-centered clinical decision support (PC CDS) and (2) identify future directions for PC CDS.: Materials and methods: We engaged a technical expert panel, conducted a scoping ... ...

Abstract	Objective: We conducted a horizon scan to (1) identify challenges in patient-centered clinical decision support (PC CDS) and (2) identify future directions for PC CDS. Materials and methods: We engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. We qualitatively analyzed literature and interview transcripts, mapping findings to the 4 phases for translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Results: We identified 12 challenges for PC CDS development. Lack of patient input was identified as a critical challenge. The key informants noted that patient input is critical to prioritizing topics for PC CDS and to ensuring that CDS aligns with patients' routine behaviors. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. We found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in our understanding of PC CDS' impact. Across all phases of CDS development, there is a lack of patient and provider trust and limited attention to patients' and providers' concerns. Discussion: These challenges suggest opportunities for advancing PC CDS. There are opportunities to develop industry-wide practices and standards to increase transparency, standardize terminologies, and incorporate patient input. There is also opportunity to engage patients throughout the PC CDS research process to ensure that outcome measures are relevant to their needs. Conclusion: Addressing these challenges and embracing these opportunities will help realize the promise of PC CDS-placing patients at the center of the healthcare system.
MeSH term(s)	Decision Support Systems, Clinical ; Humans ; Patient-Centered Care
Language	English
Publishing date	2022-05-09
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/ocac059
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Article ; Online: The technical landscape for patient-centered CDS: progress, gaps, and challenges.

Dullabh, Prashila / Heaney-Huls, Krysta / Lobach, David F / Hovey, Lauren S / Sandberg, Shana F / Desai, Priyanka J / Lomotan, Edwin / Swiger, James / Harrison, Michael I / Dymek, Chris / Sittig, Dean F / Boxwala, Aziz

Journal of the American Medical Informatics Association : JAMIA

2022 Volume 29, Issue 6, Page(s) 1101–1105

Abstract: Supporting healthcare decision-making that is patient-centered and evidence-based requires investments in the development of tools and techniques for dissemination of patient-centered outcomes research findings via methods such as clinical decision ... ...

Abstract	Supporting healthcare decision-making that is patient-centered and evidence-based requires investments in the development of tools and techniques for dissemination of patient-centered outcomes research findings via methods such as clinical decision support (CDS). This article explores the technical landscape for patient-centered CDS (PC CDS) and the gaps in making PC CDS more shareable, standards-based, and publicly available, with the goal of improving patient care and clinical outcomes. This landscape assessment used: (1) a technical expert panel; (2) a literature review; and (3) interviews with 18 CDS stakeholders. We identified 7 salient technical considerations that span 5 phases of PC CDS development. While progress has been made in the technical landscape, the field must advance standards for translating clinical guidelines into PC CDS, the standardization of CDS insertion points into the clinical workflow, and processes to capture, standardize, and integrate patient-generated health data.
MeSH term(s)	Decision Support Systems, Clinical ; Humans ; Patient-Centered Care ; Workflow
Language	English
Publishing date	2022-03-09
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/ocac029
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Article ; Online: Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards.

Lobach, David F / Boxwala, Aziz / Kashyap, Nitu / Heaney-Huls, Krysta / Chiao, Andrew B / Rafter, Thomas / Lomotan, Edwin A / Harrison, Michael I / Dymek, Chris / Swiger, James / Dullabh, Prashila

Applied clinical informatics

2022 Volume 13, Issue 5, Page(s) 1163–1171

Abstract: Background: Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare ... ...

Abstract	Background: Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperability Resources (FHIR) offers a standards-based application programming interface (API) that may support such integration. Objective: We aimed to use interoperability standards to integrate a patient mobile application (coronavirus 2019 [COVID-19] Tracker) with an EHR. The COVID-19 Tracker engages patients by sending introductory and reminder text messages, collecting vital signs and symptom data from COVID-19 patients, and providing actionable guidance if concerning issues are identified. This case report explored the use of FHIR APIs to integrate the app into EHR-enabled clinical workflows. Methods: The authors used notes from project meetings and from semistructured discussions among the application development team to track the design and implementation processes. Seven points of integration between the application and the EHR were identified, and approaches using FHIR to perform these integrations were delineated. Results: Although this clinical decision support integration project benefited from its standards-based approach, many challenges were encountered. These were due to (1) partial implementation of the FHIR standard in the EHR, particularly, components needed for patient engagement applications; (2) limited experience with the adoption of FHIR standards; and (3) gaps in the current FHIR standard. Alternative approaches, often not based on interoperability standards, were developed to overcome these limitations. Conclusion: Despite the challenges encountered due to the early stages of FHIR development and adoption, FHIR standards provide a promising mechanism for overcoming longstanding barriers and facilitating the integration of patient engagement apps with EHRs. To accelerate the integration of apps into clinical workflows, additional components of the FHIR standard must be implemented within the EHR and other clinical systems. Continued expansion of available FHIR resources will help with tighter workflow integration.
MeSH term(s)	Humans ; Electronic Health Records ; Workflow ; Mobile Applications ; Patient Participation ; COVID-19/epidemiology ; Health Level Seven
Language	English
Publishing date	2022-12-14
Publishing country	Germany
Document type	Case Reports ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0042-1758736
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: 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 01, 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 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.
Keywords	application programming interface ; Fast Healthcare Interoperability Resources ; electronic health records ; interoperability ; medical devices
Language	English
Publishing date	2020-01-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0039-1701001
Database	Thieme publisher's database

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