Healthcare systems collaborating to implement a shared decision-making tool in the electronic health record and build evidence on its adoption and use

Abstract

Introduction: Shared decision-making (SDM) is a method of care by which patients and clinicians work together to co-create a plan of care. Electronic health record (EHR) integration of SDM tools may increase adoption of SDM. We conducted a "lightweight" integration of a freely available electronic SDM tool, CV Prevention Choice, within the EHRs of three healthcare systems. Here, we report how the healthcare systems collaborated to achieve integration.

Methods: This work was conducted as part of a stepped wedge randomized pragmatic trial. CV Prevention Choice was developed using guidelines for HTML5-based web applications. Healthcare systems integrated the tool in their EHR using documentation the study team developed and refined with lessons learned after each system integrated the electronic SDM tool into their EHR. CV Prevention Choice integration populates the tool with individual patient data locally without sending protected health information between the EHR and the web. Data abstraction and secure transfer systems were developed to manage data collection to assess tool implementation and effectiveness outcomes.

Results: Time to integrate CV Prevention Choice in the EHR was 12.1 weeks for the first system, 10.4 weeks for the second, and 9.7 weeks for the third. One system required two 1-hour meetings with study team members and two healthcare systems required a single 1-hour meeting. Healthcare system information technology teams collaborated by sharing information and offering improvements to documentation. Challenges included tracking CV Prevention Choice use for reporting and capture of combination medications. Data abstraction required refinements to address differences in how each healthcare system captured data elements.

Conclusion: Targeted documentation on tool features and resource mapping supported collaboration of IT teams across healthcare systems, enabling them to integrate a web-based SDM tool with little additional research team effort or oversight. Their collaboration helped overcome difficulties integrating the web application and address challenges to data harmonization for trial outcome analyses.

Keywords: data harmonization; electronic health record; embedded research; implementation science; pragmatic trials; shared decision‐making.

FIGURE 1

CV Prevention Choice: Patient information to calculate cardiovascular risk can be manually entered into the web‐based app or autopopulated from the electronic health record (left). The infographic displays current risk, as well as future risk after options for treatment are discussed and selected (right).

FIGURE 2

Staged integration for collaboration and learning: The central research team created initial electronic health record integration documentation and worked with each participating healthcare system sequentially. Between each healthcare system's integration, documentation was updated to reflect changes and refinement. Challenges in the first two healthcare systems were addressed and reflected in documentation edits for the next round.

FIGURE 3

Building a web integration record: A snapshot of the view of CV Prevention Choice integration in the electronic health record.