Rina V. Dhopeshwarkar, MPH; Sofia Ryan, MSPH; James Swiger, MBE; Edwin A. Lomotan, MD FAMIA; Priyanka Desai, PhD, MPH; Prashila Dullabh, MD, FAMIA
What is Patient-Centered Clinical Decision Support?
Patient-centered clinical decision support (PC CDS) (PDF, 234KB) are digital health tools that help patients, caregivers, and their clinical care teams make health decisions that are evidence-based and consider a patient’s needs, values, and preferences. PC CDS significantly incorporates patient-centered factors related to knowledge, data, delivery, and use. By improving access to health data and facilitating shared decision making with their clinical care teams, PC CDS tools can enable patients and their caregivers to take a more active role in managing their health and adopt healthier lifestyles.
Despite its promise, there is a need for new resources to address common barriers to developing and implementing PC CDS. To address these gaps, the Agency for Healthcare Research and Quality (AHRQ) funded the Clinical Decision Support Innovation Collaborative (CDSiC) in 2021 to support the advancement and adoption of PC CDS. For the past four years, the CDSiC has engaged a broad community of stakeholders – including patients and caregivers, clinicians, electronic health record (EHR) and PC CDS developers, payors, and researchers – to develop resources and carry out demonstration projects related to PC CDS. This work examines how to develop, implement, and assess PC CDS tools to better support patient-centered care delivery and ultimately improve health outcomes for patients.
How can PC CDS Support Current National Health Priorities?
Current national health priorities focus on engaging patients in healthy lifestyles and wellness planning, as well as preventing and managing chronic conditions. The CDSiC has convened three Annual Meetings to engage with PC CDS stakeholders to ensure that the CDSiC’s efforts are aligned with the ever-changing needs of the field. In the third and final Annual Meeting, attendees examined the promise of PC CDS in addressing national health priorities focused on wellness and prevention. In particular, they highlighted how PC CDS can be used to empower patients to manage their chronic conditions and make healthier lifestyle choices, and to help clinicians and health systems deliver high-quality, efficient care. Three key themes from the meeting, described below, make the case for why investing in PC CDS research and innovation can help achieve national health priorities and ultimately promote better health outcomes.
PC CDS tools can help patients/caregivers and their care teams make decisions about proactive lifestyle changes. We are at a pivotal point in healthcare where digital tools offer opportunities for people to take better care of themselves. PC CDS can “coach” patients by sharing practical suggestions for lifestyle changes along with information that helps patients understand the “why” and “how” for healthy behaviors. Expanding the capabilities of PC CDS to further leverage patient-provided health and preference data (PDF, 601KB) would allow for more personalized lifestyle change options to patients, which in turn can help motivate patients to adhere to their wellness plans.
PC CDS tools can support patients in managing their chronic conditions by encouraging progress and tracking changes in health conditions. More consistent interaction with patients (e.g., through reminders and regular motivation) is important to sustain new lifestyle changes. Additional changes may include modifications to nutrition and diet, or increased exercise. PC CDS tools can help with this because they are often used by patients outside of normal healthcare visits (PDF, 1.4MB). PC CDS can integrate with home medical devices (e.g., glucose monitors, fitness watches) to routinely collect different types of information to track patients’ health and offer more relevant and timely recommendations. The recent rise of artificial intelligence (AI) use in healthcare is also a noteworthy avenue for PC CDS expansion – generative AI-driven algorithms can recognize patterns in patient-provided data, giving patients and their clinicians new insights to help identify more targeted health improvement strategies. However, given potential risks with AI (PDF, 1.6MB), patients should be informed when AI-supported tools are used in their care.
PC CDS can support the delivery of more cost-efficient care. Keeping patients healthy and out of the hospital is an important component of value-based care. Through reminders for screenings, more consistent messaging across clinicians, and other care coordination features, PC CDS promotes better self-management and can help avoid reactive care, which can be more costly than preventive care. For example, PC CDS could support more efficient interactions with the healthcare system if patient self-triage systems, including those supported by AI, are expanded. By facilitating patient self-triage, PC CDS tools can help reduce overreliance on emergency departments as a “catch all” for patient health events, alleviating clinician burden.
What Else is Needed to Help PC CDS Reach Its Potential?
Discussions from the CDSiC Annual Meeting have made it clear that PC CDS has great potential to promote healthy lifestyle changes and empower patients to take charge of their own health. In fact, expanded use of PC CDS tools may be key to achieving national health priorities related to wellness planning. However, there are several overarching considerations to address in order for PC CDS tools to meet their full potential and be scaled more widely across health systems,
- More resources to support patient co-design of PC CDS tools are needed to ensure their uptake and effectiveness. Co-design can help improve the patient-centeredness of digital tools by ensuring patients’ needs and context are accurately reflected (PDF, 721KB), which facilitates shared decision making. Soliciting iterative feedback from patients and caregivers in PC CDS co-design through focus groups, prototype testing, and usability testing helps PC CDS implementers better understand patients’ expertise and life experience. However, it can be difficult to prioritize iterative co-design with patients during PC CDS development and implementation due to time and budget constraints (PDF, 698KB). When introducing a new PC CDS tool into the workflow, health systems leaders should plan for sufficient time, staffing, and resources to conduct patient-centered feedback sessions, and utilize feedback to improve the PC CDS.
- Advancing interoperability between apps and EHRs is critical. To support effective care coordination, PC CDS must be interoperable within and across the health IT systems that care teams use, particularly EHRs. A lack of interoperability between apps causes a burden to patients, as it can contribute to incomplete medical records. Greater coordination is needed across app and EHR developers to ensure patient data collected by apps can be integrated into clinician workflows, shared between members of a care team, and used to facilitate decision making.
- Patient burden needs to be minimized. To be effective, PC CDS must fit smoothly into patients’ daily activities, or “lifeflows” and accommodate the real-world contexts in which patients interact with these tools. This is especially important given the increased use of mobile apps to manage patients’ conditions outside of clinical encounters. Health systems should consider and optimize the timepoints for patients to interact with PC CDS both before, during, and after healthcare encounters. Patients may face burden when providing data to PC CDS tools, especially if they routinely use multiple tools or apps to manage their conditions. It is critical to gather patients’ perspectives on respondent burden to ensure patient data is pragmatically collected and used as part of the decision making process.
- Explore different modes of PC CDS delivery. In today’s constantly expanding digital ecosystem, PC CDS has the opportunity to take many different forms. From health management apps, to AI chatbots, to text messages sent directly from a health system, there are a myriad of ways that PC CDS can reach patients. To expand the reach of PC CDS, health systems leaders must consider the best modality to utilize to reach their patient populations and meet their specific needs, given available resources. For example, text message-facilitated PC CDS (PDF, 1.1MB) represents a low-cost, customizable, and easily automated way to efficiently reach patients across a range of clinical conditions, including women’s health, preventive care and chronic disease management.
If designed and used effectively, PC CDS can be critical tools to address the nation’s current health priorities. By improving care coordination, collecting patient-provided health data, and giving patients the information they need to stay healthy, PC CDS tools can promote evidence-based prevention of illness and empower people to achieve their health goals.