Implementing USPSTF Recommendations for Breast Cancer Screening and Prevention by Integrating Clinical Decision Support Tools with the Electronic Health Record

项目概要/摘要 乳腺癌筛查和预防的临床建议取决于乳腺癌风险， 然而，准确确定6300万有资格获得服务的妇女的风险的方法并没有广泛使用， 实践MammoScreen是一种基于网络的临床决策支持工具应用程序，专为女性设计 年龄在40-74岁之间，以确定他们患乳腺癌的个体风险，让患者参与共同决策， 指导转介，并考虑筛选决定。患者根据其风险获得量身定制的信息 根据USPSTF的建议进行配置文件和偏好。数字医疗的目标是 该研究项目的目的是改善对妇女的护理，并提高护理质量，因为妇女是澳大利亚人权问题咨询机构的优先群体。 尽管有许多乳腺癌风险评估工具可供使用，但没有一个与 患者的电子健康记录（EHR），错过了充分整合患者的重要机会 在护理点将信息纳入预防决策。MammoScreen的开发和以前 由拟议项目的跨学科调查小组进行测试。在一项试点研究中， MammoScreen需要手动输入EHR，这在大型卫生系统中是不可行的。 拟议的项目创新地使用了SMART（可替代医疗应用， FHIR（快速医疗保健互操作性资源）标准上的数据交换 EHR外部的应用程序，如MammoScreen，将其完全集成到常规医疗保健中。的 在FHIR标准上使用SMART将允许这种方法不仅扩展到单个卫生系统， 而且适用于支持SMART on FHIR标准的任何EHR系统。 本项目的目标是证明EHR安全交换信息的能力 与MammoScreen使用可互操作的、基于标准的方法;提供适当的临床和患者 为用户提供决策支持;并使用基于以下内容的混合方法评估其在患者和临床医生中的使用 RE-AIM框架（Reach，Effectiveness，Adoption，Implementation and Maintenance）完成 这些目标将为与其他类型的医疗保健相关应用程序的集成奠定基础 旨在将决策支持扩展到临床环境之外。 目标1（第1年和第2年）：实现基于标准、安全、可靠、可互操作的 MammoScreen与EHR。 目标2（第1年和第2年，第3年和第4年）评估患者对MammoScreen的接受程度， 临床医生识别并消除潜在的使用障碍。 目标3（3-5岁）：评价临床医生和不同年龄患者对EHR集成MammoScreen的使用 组（40-49岁; 50-74岁）并测量临床结果。

Project Summary/Abstract Clinical recommendations for breast cancer screening and prevention are contingent on breast cancer risk, yet methods to accurately determine risk for the 63 million women eligible for services are not widely used in practice. MammoScreen, a web-based application of a clinical decision support tool, was designed for women ages 40–74 years to identify their individual risks for breast cancer, engage patients in shared decision making, guide referrals, and consider screening decisions. Patients receive tailored information based on their risk profiles and preferences in accordance with USPSTF recommendations. The goal of this digitial healthcare research project is to improve access and quality of care for women, an AHRQ priority population. Although numerous breast cancer risk assessment tools are publically available, none exchange data with the patient’s electronic health record (EHR), missing important opportunities to fully integrate patient information into prevention decision-making at point of care. MammoScreen was developed and previously tested by the interdisciplinary team of investigators for the proposed project. In a pilot study, data from MammoScreen required manual entry into the EHR, which is not feasible across large health systems. The proposed project makes innovative use of the SMART (Substitutable Medical Applications, Resuable Technologies) on FHIR (Fast Healthcare Interoperability Resources) standard to exchange data to and from applications external to the EHR, such as MammoScreen, to fully integrate them into routine healthcare. The use of the SMART on FHIR standard will allow this approach to be scaled not only to a single health system, but to any EHR system that supports the SMART on FHIR standard. The objectives of this project are to demonstrate the ability of the EHR to securely exchange information with MammoScreen using interoperable, standards-based approaches; provide appropriate clinical and patient decision support for users; and evaluate its use among patients and clinicians using mixed methods based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Accomplishing these goals would lay the groundwork for integration with other types of healthcare-related applications designed to extend decision support outside the clinical setting. Aim 1 (Years 1 & 2): Implement standards-based, safe, secure, interoperable integration of MammoScreen with the EHR. Aim 2 (Year 1 & 2 and again, Years 3 & 4) Evaluate MammoScreen acceptance by patients and clinicians to identify and remove potential barriers to use. Aim 3 (Years 3-5): Evaluate use of EHR-integrated MammoScreen by clinicians and patients across age groups (40–49 years; 50–74 years) and measure clinical outcomes.