A model to support shared decision making in electronic health records systems

Area of Science:

• Health Informatics
• Medical Decision Making
• Patient-Centered Care

Background:

• Shared decision making (SDM) involves collaboration between providers and patients in medical choices.
• Incorporating patient values and preferences improves care appropriateness, ethics, and cost-effectiveness.
• Current barriers to SDM include time constraints, lack of EHR integration, and poor communication of decision aid results.

Purpose of the Study:

• To discuss solutions for implementing SDM in routine practice.
• To explore the role of computer decision support (CDS) integrated into EHRs for facilitating SDM.
• To propose a redesign of EHRs to support SDM.

Main Methods:

• Discussion of potential solutions, including a "personalize button" for EHRs.
• Leveraging a 4-phase clinical model for SDM.
• Describing a CDS for SDM architecture built on recognized EHR standards.

Main Results:

• EHRs can be a significant barrier to SDM if not redesigned.
• CDS integrated into EHRs can support SDM by reminding providers and monitoring care alignment with patient preferences.
• Further development is needed for preference modeling and rapid communication to clinicians.

Conclusions:

• Redesigning EHRs is crucial to overcome barriers and promote SDM.
• Computer decision support (CDS) technologies can transform EHRs into powerful tools for facilitating SDM.
• Effective EHR integration can ensure healthcare delivery respects patient preferences.