Patient-Centered Clinical Decision Support Challenges and Opportunities Identified From Workflow Execution Models

OBJECTIVE: To use workflow execution models to highlight new considerations for patient-centered clinical decision support policies (PC CDS), processes, procedures, technology, and expertise required to support new workflows. METHODS: To generate and refine models, we used (1) targeted literature reviews; (2) key informant interviews with 6 external PC CDS experts; (3) model refinement based on authors\u27 experience; and (4) validation of the models by a 26-member steering committee. RESULTS AND DISCUSSION: We identified 7 major issues that provide significant challenges and opportunities for healthcare systems, researchers, administrators, and health IT and app developers. Overcoming these challenges presents opportunities for new or modified policies, processes, procedures, technology, and expertise to: (1) Ensure patient-generated health data (PGHD), including patient-reported outcomes (PROs), are documented, reviewed, and managed by appropriately trained clinicians, between visits and after regular working hours. (2) Educate patients to use connected medical devices and handle technical issues. (3) Facilitate collection and incorporation of PGHD, PROs, patient preferences, and social determinants of health into existing electronic health records. (4) Troubleshoot erroneous data received from devices. (5) Develop dashboards to display longitudinal patient-reported data. (6) Provide reimbursement to support new models of care. (7) Support patient engagement with remote devices. CONCLUSION: Several new policies, processes, technologies, and expertise are required to ensure safe and effective implementation and use of PC CDS. As we gain more experience implementing and working with PC CDS, we should be able to begin realizing the long-term positive impact on patient health that the patient-centered movement in healthcare promises

A Lifecycle Framework Illustrates Eight Stages Necessary for Realizing the Benefits of Patient-Centered Clinical Decision Support

The design, development, implementation, use, and evaluation of high-quality, patient-centered clinical decision support (PC CDS) is necessary if we are to achieve the quintuple aim in healthcare. We developed a PC CDS lifecycle framework to promote a common understanding and language for communication among researchers, patients, clinicians, and policymakers. The framework puts the patient, and/or their caregiver at the center and illustrates how they are involved in all the following stages: Computable Clinical Knowledge, Patient-specific Inference, Information Delivery, Clinical Decision, Patient Behaviors, Health Outcomes, Aggregate Data, and patient-centered outcomes research (PCOR) Evidence. Using this idealized framework reminds key stakeholders that developing, deploying, and evaluating PC-CDS is a complex, sociotechnical challenge that requires consideration of all 8 stages. In addition, we need to ensure that patients, their caregivers, and the clinicians caring for them are explicitly involved at each stage to help us achieve the quintuple aim

From Investment Rules of Thumb to Routines: A Real Option Approach

This paper examines the role of budgeting and decision tools in the strategizing and decision processes and their effect on future routines of the firm. It argues that some conditions must be fulfilled by the decision tools to facilitate the change of the firm routines. The reflection is conducted by analyzing the condition of existence of routines. Routines, as a redundant pattern of action, are essential units of analysis in the evolutionary approach of the firm and in strategic change management. The argument of the work is that for being able to produce new routines a strategic decision--and the way this decision is formulated by using budgeting tools--must have as many common characteristics with the routines as possible. The principal strategic decision tools we study are scenario analysis and real option. The paper concludes that the decision tools can and do influence the routines and the further development capacities of the firm. Therefore if the representation of the future development of a firm is dependent on the vision of the manager, this vision finds a follow-up in the decision tools used