FHIR-ed Up for Tobacco Cessation

总结 烟草使用仍然是美国主要的可预防死亡原因， 每年过早死亡。行之有效的烟草治疗指南和最近发布的 美国心脏病学会戒烟治疗专家共识决策途径 强调有必要将烟草使用概念化为一种慢性物质使用障碍， 使用烟草制品的人进行简短干预，包括经证实的药物吸烟处方 戒烟援助和积极主动的联系，以证据为基础的行为支持。智能的快速扩张 电话功能增强了戒烟应用程序个性化行为改变指导的潜力 并发送与情境相关的量身定制的行为改变轻推，不仅基于戒烟的准备程度， 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 通过快速医疗保健互操作性资源（FHIR）标准应用程序的健康应用程序（iOS） 编程接口（API）。拟议的研究代表了一种创新的方法，因为它将发展 并检验FHIR-ed Up的可行性、可接受性和初步效果--一个有理论基础的， 高度个性化的戒烟健康工具包功能的应用程序。与现有的戒烟应用程序不同，FHIR- 艾德Up将：1）在量身定制的健康行为改变沟通中实施全方位的最佳实践; 2） 基于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HL 7传输从FHIR的服务器部分返回到电子健康记录的关键见解 与互操作性和应用程序开发专家合作开发，FHIR-ed Up将 通过为患者提供高度个性化的用户体验并整合可操作的 无缝洞察临床医生的临床工作流程。广泛的最终用户和利益相关者投入将 确保FHIR-ed Up旨在快速传播。潜在的最终用户（n=8名18岁和 将通过社区和社交媒体广告招募。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-ed Up原型。迭代 可用性测试（n=10）将允许在患者使用集成输送系统之前对原型进行改进 与即将到来的任命（n=100）被招募参加为期30天的试点测试。试点参与方 将提供定量和定性数据，并将审查使用和可接受性数据。岗前 对吸烟的社会心理预期的比较将提供关于吸烟对健康的影响的初步数据。 程序.接受和提供EHR提示的参与临床医生（n=5）的可接受性数据也将 聚集。结果将告知进行第二阶段有效性所需的程序修改 审判第二阶段将推动一种具有成本效益、以证据为基础、可互操作的 该应用程序有可能在人口基础上解决烟草使用问题。

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.