Advancing patient-centered clinical decision support in today's health care ecosystem: key themes from the Clinical Decision Support Innovation Collaborative's 2023 Annual Meeting.

Objective: This perspective summarizes key themes that arose from stakeholder discussions at the inaugural Clinical Decision Support Innovation Collaborative (CDSiC) 2023 Annual Meeting. The CDSiC is an Agency for Healthcare Research and Quality (AHRQ)-funded innovation hub for patient-centered clinical decision support (PC CDS).

Materials And Methods: The meeting took place on May 16-17, 2023, and engaged 73 participants that represented a range of stakeholder groups including researchers, informaticians, federal representatives, clinicians, patients, and electronic health record developers.

Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities.

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.

Patient-Centered Clinical Decision Support-Where Are We and Where to Next?

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.

Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support.

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.

A lifecycle framework illustrates eight stages necessary for realizing the benefits of patient-centered clinical decision support.

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.

Incorporating Social Determinants of Health in Electronic Health Records: Qualitative Study of Current Practices Among Top Vendors.

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.

Patient experience over time in patient-centered medical homes.

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.

Accuracy of electronically reported "meaningful use" clinical quality measures: a cross-sectional study.

Background: The federal Electronic Health Record Incentive Program requires electronic reporting of quality from electronic health records, beginning in 2014. Whether electronic reports of quality are accurate is unclear.

Objective: To measure the accuracy of electronic reporting compared with manual review.

Electronic health records and ambulatory quality of care.

Context: The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect.

Objective: To determine the effect of EHRs on ambulatory quality in a community-based setting.

Health care consumers' preferences around health information exchange.

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.

Which components of health information technology will drive financial value?

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.

Low-income, ethnically diverse consumers' perspective on health information exchange and personal health records.

We surveyed low-income, ethnically diverse consumers regarding their attitudes towards providers' use of electronic health information exchange (HIE) and consumer use of HIE through personal health records (PHRs). Amongst respondents (n=214), 48% had an annual household income below $15,000 and 62% spoke a language other than English at home. A majority indicated that they supported providers' use of HIE (61%).

Evaluating health information technology in community-based settings: lessons learned.

Implementing health information technology (IT) at the community level is a national priority to help improve healthcare quality, safety, and efficiency. However, community-based organizations implementing health IT may not have expertise in evaluation. This study describes lessons learned from experience as a multi-institutional academic collaborative established to provide independent evaluation of community-based health IT initiatives.

Consumer attitudes toward personal health records in a beacon community.

Objective: To characterize consumers' attitudes about personal health records (PHRs), electronic tools that enable consumers to securely access, manage, and share their health information, in a community participating in health information technology initiatives.

Study Design: Cross-sectional study.

Methods: A random-digit-dial telephone survey about PHRs was conducted among adult residents of New York State's greater Buffalo region.

Healthcare consumers' attitudes towards physician and personal use of health information exchange.

Background: Health information exchange (HIE), the electronic transmission of patient medical information across healthcare institutions, is on the forefront of the national agenda for healthcare reform. As healthcare consumers are critical participants in HIE, understanding their attitudes toward HIE is essential.

Objective: To determine healthcare consumers' attitudes toward physician and personal use of HIE, and factors associated with their attitudes.

Consumer support for health information exchange and personal health records: a regional health information organization survey.

In order to characterize consumer support for electronic health information exchange (HIE) and personal health records (PHRs) in a community where HIE is underway, we conducted a survey of English speaking adults who visited primary care practices participating in a regional community-wide clinical data exchange, during August, 2008. Amongst the 117 respondents, a majority supported physicians' use of HIE (83%) or expressed interest in potentially using PHRs (76%). Consumers' comfort sending personal information electronically over the Internet and their perceptions regarding the potential benefits of HIE were independently associated with their support for HIE.

User experiences with pharmacy benefit manager data at the point of care.

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.

Measuring the effects of health information technology on quality of care: a novel set of proposed metrics for electronic quality reporting.

Background: Electronic health records (EHRs), in combination with health information exchange, are being promoted in the United States as a strategy for improving quality of care. No single metric set exists for measuring the effectiveness of these interventions. A set of quality metrics was sought that could be retrieved electronically and would be sensitive to the changes in quality that EHRs with health information exchange may contribute to ambulatory care.

Quality measures for capturing the effects of health information exchange.

Existing quality measures may not be sensitive to the effects of sharing clinical data across health care providers or institutions. Our objective is to develop and validate a modified set of quality measures that is: 1) sensitive to the types of improvements in quality that health IT with HIE may contribute to ambulatory care and 2) electronically retrievable from electronic health records (EHRs) or other electronic sources.