The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

Abstract

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

Keywords

chronic diseases electronic health records shared decision making

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References

Bot

AGJ

Bossen

JKJ

Herndon

Ruchelsman

Ring

Vranceanu

. Informed shared decision-making and patient satisfaction. Psychosomatics. 2014;55(6):586–94.

Elwyn

Frosch

Thomson

et al . Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.

Stacey

Legare

Col

et al . Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;(1):CD001431.

Oshima

Emanuel

. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368(1):6–8.

Arterburn

Wellman

Westbrook

et al . Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff (Millwood). 2012;31(9):2094–104.

Barry

Edgman-Levitan

. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.

The SHARE Approach. 2016. Available from: http://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html

Gillick

. Re-engineering shared decision-making. J Med Ethics. 2015;41(9):785–8.

Stacey

Legare

Pouliot

Kryworuchko

Dunn

. Shared decision making models to inform an interprofessional perspective on decision making: a theory analysis. Patient Educ Couns. 2010;80(2):164–72.

10.

Friedberg

Van Busum

Wexler

Bowen

Schneider

. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Aff (Millwood). 2013;32(2):268–75.

11.

Joseph-Williams

Elwyn

Edwards

. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94(3):291–309.

12.

Otte-Trojel

de Bont

Rundall

van de Klundert

. How outcomes are achieved through patient portals: a realist review. J Am Med Inform Assoc. 2014;21(4):751–7.

13.

Liebovitz

. Meaningful EHR attributes for an era of accountability, transparency, shared decision making, and value assessment. J Leg Med. 2013;34(1):43–53.

14.

Davis

Roudsari

Raworth

Courtney

MacKay

. Shared decision-making using personal health record technology: a scoping review at the crossroads. J Am Med Inform Assoc. 2017;24(4):857–66.

15.

Liberati

Altman

Tetzlaff

et al . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.

16.

Teasell

Bayona

Marshall

et al . A systematic review of the rehabilitation of moderate to severe acquired brain injuries. Brain Inj. 2007;21(2):107–12.

17.

Grant

Wald

Schnipper

Gandhi

et al . Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2008;168(16):1776–82.

18.

Mann

Lin

. Increasing efficacy of primary care-based counseling for diabetes prevention: rationale and design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) trial. Implement Sci. 2012;7:6.

19.

Chrimes

Kitos

Kushniruk

Mann

. Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record. Int J Med Inform. 2014;83(9):636–47.

20.

Mann

Palmisano

Lin

. A pilot randomized trial of technology-assisted goal setting to improve physical activity among primary care patients with prediabetes. Prev Med Rep. 2016;4:107–12.

21.

Fiks

Mayne

Karavite

et al . Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics. 2015;135(4):e965–73.

22.

Smallwood

Schapira

Fedders

Neuner

. A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal. Osteoporos Int. 2017;28(2):567–76.

23.

Krist

Woolf

Hochheimer

et al . Harnessing information technology to inform patients facing routine decisions: cancer screening as a test case. Ann Fam Med. 2017;15(3):217–24.

24.

Gulbrandsen

Clayman

Beach

et al . Shared decision-making as an existential journey: aiming for restored autonomous capacity. Patient Educ Couns. 2016;99(9):1505–10.

25.

Lenert

Dunlea

Del Fiol

Hall

. A model to support shared decision making in electronic health records systems. Med Decis Making. 2014;34(8):987–95.

26.

Legare

Brouillette

. Shared decision-making in the context of menopausal health: where do we stand? Maturitas. 2009;63(3):169–75.

27.

Gravel

Legare

Graham

. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions. Implement Sci. 2006;1:16.

28.

Legare

Ratte

Stacey

. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014;(9):CD006732.

29.

Cook

Teixeira

Heale

Cimino

Del Fiol

. Context-sensitive decision support (infobuttons) in electronic health records: a systematic review. J Am Med Inform Assoc. 2016;24(2):460–8.

30.

Goroll

. Emerging from EHR purgatory—moving from process to outcomes. N Engl J Med. 2017;376(21):2004–6.

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