Feasibility study of an EHR-integrated mobile shared decision making application

Frank C Day; Mohammad Pourhomayoun; Deidre Keeves; Andrew F Lees; Majid Sarrafzadeh; Douglas Bell; Michael A Pfeffer

doi:10.1016/j.ijmedinf.2019.01.008

Feasibility study of an EHR-integrated mobile shared decision making application

Int J Med Inform. 2019 Apr:124:24-30. doi: 10.1016/j.ijmedinf.2019.01.008. Epub 2019 Jan 11.

Authors

Frank C Day¹, Mohammad Pourhomayoun², Deidre Keeves³, Andrew F Lees⁴, Majid Sarrafzadeh⁵, Douglas Bell⁶, Michael A Pfeffer⁷

Affiliations

¹ Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 924 Westwood Blvd Ste 300, Los Angeles, CA, 90024, USA. Electronic address: fday@mednet.ucla.edu.
² Computer Science, California State University, Los Angeles, CA, USA.
³ Information Services and Solutions, UCLA, Los Angeles, CA, USA.
⁴ Internal Medicine, University of Washington, Seattle, WA, USA.
⁵ Computer Science and Electrical Engineering, UCLA, Los Angeles, CA, USA.
⁶ Clinical and Translational Science Institute, UCLA, Los Angeles, CA, USA.
⁷ Department of Medicine, UCLA, Los Angeles, CA, USA.

PMID: 30784423
DOI: 10.1016/j.ijmedinf.2019.01.008

Abstract

Introduction: Integrating mobile applications (apps) into users' standard electronic health record (EHR) workflows may be valuable, especially for apps that both read and write data. This report details the lessons learned during the integration of a patient decision aid - prostate specific antigen (PSA) testing for prostate cancer screening - into our users' standard EHR workflow for a small usability assessment.

Materials and methods: This feasibility study included two steps. First we enabled realtime, secure bidirectional data exchange between the mobile app and EHR for 14 data elements, and second we pilot tested the production environment app with 9 primary care patients aged 60-65 years. Our primary usability metric was a net promoter score (NPS), based on users' recommendation of the app to a friend or family member; we also assessed the proportion of users who 1) updated their prostate cancer risk factor information present in the EHR and 2) submitted more than one unique response regarding their preference to have PSA testing.

Results: The seven web services necessary to read and write data required considerable configuration, but successfully delivered risk factor-specific educational content and recorded patients' values and decision preference directly within the EHR. Seven of the 9 patients (78%) would recommend this app to a friend/family member (NPS = 55.6%), one patient used the app to update risk factor information, and 4/9 (44%) changed their decision preference while using the app.

Conclusions: It is feasible to implement a decision aid directly into users' standard EHR workflow for limited usability testing. Broad scale implementation may have a positive effect on patient engagement and improve shared decision making, but several challenges exist with proprietary EHR vendor application programming interfaces (API)s.

Keywords: Clinical informatics; Decision making; Electronic health records; mobile applications.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Decision Making*
Early Detection of Cancer
Electronic Health Records*
Feasibility Studies
Humans
Male
Middle Aged
Mobile Applications
Prostate-Specific Antigen / analysis
Prostatic Neoplasms / diagnosis*
User-Computer Interface

Substances

Prostate-Specific Antigen