FHIR-ed Up for Tobacco Cessation

摘要 烟草使用仍然是美国可预防的主要死亡原因，导致超过48万人死亡 每年都会过早死亡。制定完善的烟草治疗指南，并于最近发布 美国心脏病学会戒烟治疗专家共识决策路径 强调有必要将烟草使用概念化为一种慢性物质使用障碍，并向任何患者提供 世卫组织使用烟草产品的简要干预措施，包括已证实的药理吸烟处方 戒烟辅助工具和主动与循证行为支持的联系。SMART的快速扩张 手机功能增强了戒烟应用程序个性化行为改变指导的潜力 不仅基于戒烟的准备，还根据戒烟的准备，发送与上下文相关的量身定做的行为改变提示 基于电子健康记录(EHR)数据。来自EHR的丰富数据现在可供第三方应用程序使用 通过快速医疗互操作性资源(FHIR)标准应用程序实现的健康应用程序(IOS) 编程接口(API)。拟议的研究代表了一种创新的方法，因为它将开发 并检查FIR UP的可行性、可接受性和初步效果-一种有理论基础的、 高度个性化的戒烟健康套件启用的应用程序。与现有的戒烟应用程序不同，Fhir- ED UP将：1)在量身定制的健康行为改变沟通方面实施全面的最佳实践；2) 根据健康应用程序数据和行为改变结构个性化消息传递；以及3)提供数据和 通过服务器的HL7传输返回电子健康记录的关键见解-FHIR的一部分 打开应用程序。与互操作性和应用程序开发专家合作开发，FHIR UP将 通过为患者提供高度个性化的用户体验并将可操作的 无缝洞察其临床医生的临床工作流程。最终用户和利益相关者的广泛投入将 确保Fired Up设计用于快速传播。潜在最终用户(n=8名18岁及以上的烟草使用者 年长的)将通过社区和社交媒体广告招聘。形成性定性数据将与 来自四位专家和五位临床医生利益相关者的意见，以开发FHIR-UP原型。迭代 可用性测试(n=10)将允许在患者使用集成交付系统之前对原型进行改进 即将被任命(n=100)的人被招募参加为期30天的试点测试。试点参与者 将提供定量和定性数据，并将审查利用率和可接受性数据。发布前 吸烟的心理社会期望的比较将提供关于吸烟影响的初步数据 程序。来自接收和传递电子病历提示的参与临床医生(n=5)的可接受性数据也将 被聚集在一起。结果将为进行第二阶段有效性所需的计划修改提供信息 审判。第二阶段将推动具有成本效益、以证据为基础、可互操作的 有可能以人口为基础解决烟草使用问题的应用程序。

Summary Tobacco use remains the leading preventable cause of death in the US, contributing to more than 480,000 premature deaths each year. The well-established Tobacco Treatment Guidelines and recently released American College of Cardiology Expert Consensus Decision Pathway for tobacco cessation treatment underscore the need to conceptualize tobacco use as a chronic substance use disorder and to offer any patients who use tobacco products brief interventions that include prescriptions for proven pharmacological smoking cessation aids and proactive connections to evidence-based behavioral support. The rapid expansion of smart phone capabilities enhances the potential for tobacco cessation apps to personalize behavior change guidance and to send contextually relevant tailored behavior change nudges based not just on readiness to quit, but also based on electronic heath record (EHR) data. Rich data from EHRs are now available to third-party apps from the Health app (iOS) via Fast Healthcare Interoperability Resources (FHIR) standard Application Programming Interface (API). The proposed research represents an innovative approach in that it will develop and examine the feasibility, acceptability, and preliminary effects of FHIR-ed Up- a theoretically-grounded, highly individualized tobacco cessation Health-Kit enabled app. Unlike existing tobacco cessation apps, FHIR- ed Up will: 1) implement a full range of best practices in tailored health behavior change communications; 2) individualize messaging based on Health app data and behavior change constructs; and 3) provide data and key insights back to electronic health records via HL7 transmissions from the server-portion of the FHIR-ed Up app. Developed in collaboration with interoperability and app development experts, FHIR-ed Up will achieve sustained use by hyper-personalizing the user experience for patients and integrating actionable insights seamlessly into the clinical workflow of their clinicians. Extensive end user and stakeholder input will ensure FHIR-ed Up is designed for rapid dissemination. Potential end users (n=8 tobacco users aged 18 and older) will be recruited via community and social media ads. Formative qualitative data will be combined with input from four experts and five clinician stakeholders to develop a prototype of FHIR-ed Up. Iterative usability testing (n=10) will allow the prototype to be refined before patients of an integrated delivery system with an upcoming appointment (n=100) are recruited to participate in a 30-day pilot test. Pilot participants will provide quantitative and qualitative data, and utilization and acceptability data will be examined. Pre-post comparisons of psychosocial expectancies for smoking will provide preliminary data on the effects of the program. Acceptability data from participating clinicians (n=5) who receive and deliver EHR prompts will also be gathered. The results will inform program modifications needed to proceed with the Phase II effectiveness trial. Phase II will provide the impetus for commercialization of a cost-effective, evidence-based, interoperable app that has the potential to address tobacco use on a population basis.