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

Patient decision aids (PDAs) are recognized as valuable tools to support shared decision making (SDM) and several are mandated by the Centers for Medicare & Medicaid Services (CMS) for coverage determinations. However, to be successful, these aids must also follow the “5 Rights” framework, based on the 5 Rights of Clinical Decision Support, so that they contain the right information, are used with the right patients, at the right times, have the right formats, and be delivered via the right channels. Despite the proven clinical benefits of PDAs, there are still barriers limiting their use. Existing issues include the difficulty in locating appropriate PDAs at the time of care, the need to leave current workflows to find and use them, the inability to know the quality of a given PDA, and the need to manually enter data into the PDA. Integrating PDAs into electronic health records (EHRs) would remove many of these barriers; however, to date their integration into EHRs and the creation of other information technology solutions has not robustly occurred.

This research will address the implementation barriers of PDAs by creating a system called Shared Decision Aid Navigator System (SDANS). Researchers will build the system to contain a repository of the PDA metadata needed to support 5 Rights implementation; create a PDA navigator using SMART-on-FHIR standards allowing it to be reusable, interoperable, and scalable; be able to be embedded into an EHR; use PDA metadata and patient and organizational data to support clinical documentation; create a clinical quality language (CQL) rules repository to maintain PDA implementation rules; and create an application for health systems and practices to modify and maintain their PDA repository and CQL implementation rules.

The specific aims of the research are as follows:

• Build a Shared Decision Aid Navigator System that supports the “5 Rights of Shared Decision-Making Support;” addresses known implementation barriers; and is interoperable, reusable, and scalable.
• Conduct Shared Decision Aid Navigator System Proof-of-Concept Feasibility and Usability Evaluation.

Patients, clinicians, and informatics experts will be involved in designing and building SDANS, ensuring it will meet end-user needs. Three high-quality, evidence based, CMS-mandated PDAs will be converted into SMART-on-FHIR applications, allowing the researchers to assess the full functionality of SDANS. The three PDAs that will be used are implantable cardioverter defibrillator use, atrial fibrillation stroke prevention, and computerized tomography scan lung cancer screening. The system will then be implemented in four medical centers using the three converted PDAs as a proof-of-concept. An evaluation of the feasibility, functionality, and satisfaction with the system will subsequently be conducted.

SDANS has the potential to be widely deployed, allowing for the robust integration of PDAs into health systems, wider use of these important tools, and improved shared decision making and patient-centered outcomes.