An Interoperable, Reusable and Scalable Shared Decision Aid Navigator System: Supporting the 5 Rights of Patient Shared Decision-Making

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Project Summary/Abstract For clinical decision support to be effective it must provide the right information, to the right persons, at the right times, in the right formats, and via the right channels (aka ‘“The 5 Rights of CDS”). The “5 Rights of CDS” framework also applies to shared decision-making support. Shared decision-making is a patient-centered form of clinical decision-making. Patient decision aids (PDAs) are increasingly recognized as valuable tools to support shared decision making, and several are mandated by CMS for coverage determinations. To facilitate successful PDA implementation a PDA containing the right information must be provided to the right patient at the right time, in the right format, and be delivered in the right channel. Despite the proven clinical benefits of PDAs, informatics systems to reduce the barriers health systems, physicians, and patients face in using PDAs are lacking. Known limitations of PDA use include having to locate the right PDA, knowing the quality of the PDA, having to leave the electronic health record (EHR) environment to find and use the PDA, having to manually enter data into the PDA, and documenting the process of shared decision-making that was undertaken. The objective of this proposal is to create an informatics system that addresses know PDA implementation barriers, supports the “5 Rights” framework, and is built to be reusable, interoperable, and scalable. The proposed Shared Decision Aid Navigator System (SDANS) will address PDA implementation limitations by (1) creating a repository of the PDAs metadata needed to support “5 Rights” implementation, (2) creating a SMARonFHIR (SoF) EHR-embedded PDA navigator that relies on PDA metadata, patient data, and organizational data to implement the “5 Rights” and to support documentation (3) using the Fast Healthcare Interoperability Resources (FHIR) standard to retrieve patient data that can be used to support the “5 Rights” of implementation and to provide data to data-enabled PDA tools, (4) using CQL and creating a Clinical Quality Rules (CQL) rules repository to maintain PDA implementation rules, and (5) creating an administrative application for health systems and practices to modify and maintain their PDA repository and CQL implementation rules. In Aim 1 we will employ co-design principles and qualitative methods with patients, clinicians, and health information technology (HIT) experts to design and build the SDANS to ensure it meets the needs of those who will use the system. We will also convert three current high-quality, evidence-based CMS-mandated PDAs into SMARTonFHIR applications to allow us to test the full functionality of the SDANS. In Aim 2, four medical centers will deploy the SDANS and the three SOF-converted PDAs into a proof-of- concept environment and we will evaluate the feasibility, functionality and satisfaction with the system. In the long-term, the SDANS will lead to improved implementation of PDAs and meet AHRQ’s mission to improve the use of CDS, including PDAs, and to improved patient-centered outcomes.