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  1. AU="Swiger, James"
  2. AU="Loftus Jr, E. V."
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  1. 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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  2. 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, ... ...

    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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  3. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. 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

    More links

    Kategorien

  8. 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 ... ...

    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

    More links

    Kategorien

  9. Article: 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 05, 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.
    Keywords clinical decision support ; interoperability standards ; patient-generated health data
    Language English
    Publishing date 2022-10-01
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ISSN 1869-0327
    ISSN (online) 1869-0327
    DOI 10.1055/s-0042-1758736
    Database Thieme publisher's database

    More links

    Kategorien

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