How to Integrate a Patient Decision Aid into an EHR System

Integrating a patient decision aid (PDA) into the EHR is a six-step, 18-month process that requires support from a clinical champion, guidance from an experienced health IT professional, and a willing EHR vendor team, according to a study published in JMIR Publications.

A PDA provides evidence-based information in simple, digestible language to enable shared decision-making between patients and clinicians.

Although PDAs can enhance patient care, EHR integration remains a significant hurdle. Integrating outside tools into the EHR is complex and security concerns are a significant challenge, the study authors noted. 

This latest study detailed the process for implementing a patient decision aid into the EHR. The research team said the EHR integration was a six-step process.

First, the health IT team must negotiate task priority with the EHR vendor software team. The clinical champions requested EHR optimizations from the EHR vendor—for this study, Epic Systems—to provide access to the Option Grid app.

Next, the provider must gain department approval for a security risk assessment. Most providers require three levels of security checks regarding outpatient processes or menu changes, information flows, and third-party tool communication.

Third, the EHR vendor software analysts determined how much time and the number of personnel would be required for the software optimization. 

Next, researchers said to execute EHR configuration in four steps: access the app at the Epic App Orchard, enable synchronization between the app and the EHR system, test the connection, and request the app to be whitelisted to access the EHR system. 

Fifth, developers should troubleshoot to ensure menu locations, access requests, and user identifications were all functioning properly. 

After troubleshooting, developers may launch the Option Grid app to generate the PDA.

The health IT team also leveraged HL7 SMART on FHIR standard to integrate the PDA into the EHR system. The standard allowed clinicians to access the solution by utilizing sign-on credentials to prevent a security breach.

The study authors noted the importance of a clinical champion at each institution.

“Without the support of a clinical champion in each setting, we would not have been able to initiate the process of PDA integration,” wrote the study authors. “At the core of the work are issues of security and reassuring the organization that data transfers will not breach security protocols. SMART on FHIR addresses the data security requirements by allowing for better control of the information being shared with a third party such as Option Grid”

In this case, the clinical champion was an intermediary between the research team and the EHR vendor analysts. The clinical champion helped the two teams prioritize and identify the EHR menu button location to ensure visibility, the study authors said. 

Clinician input was key during integration, regardless of the format or delivery mode, the researchers added.

The study authors also noted that having an EHR expert on the team allowed for guidance and reassurance to the existing EHR vendor team.

However, the researchers faced several barriers, such as a lack of control over the PDA solution, EHR updates and maintenance, and software issues that caused delays and functionality problems.

Research revealed the importance of SMART on FHIR to standardize patient data exchange and enable EHR integration across EHR systems. The study authors said another research team recently utilized this method in a recent PDA integration study.

“However, research has focused on the interoperability of FHIR standards,” the researchers wrote. “For instance, a recent review showed how FHIR moved clinical information (medical images and quality metrics) found on different platforms in the EHR into a single platform to streamline the workflow of radiologists. Similarly, another system has used FHIR standards to collect data from multiple sources in the EHR, automate analyses of laboratory test results, and generate easy-to-read reports for patients and their clinicians.”

Although the integration was a success, the authors said whether the solution leads to patient use, remains an open question.