JMIR Publications

ABSTRACT

Background:

Some argue that successful implementation of patient decision aids (PDAs) into clinical workflows will depend on integration into electronic health records (EHR). Anecdotally, we know that EHR integration is a complex, time-consuming task, yet the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems.

Objective:

1) Identify the steps required to integrate a PDA into the Epic EHR system; 2) examine facilitators and barriers to the integration effort.

Methods:

We conducted a case study at five academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate integration of the uterine fibroid Option Grid™ PDAs into clinician-facing menus. We scheduled regular meetings with the Epic software analysts and an expert Epic technologist to discuss how best to integrate the tools into Epic for use by clinicians with patients. Meetings were recorded and transcribed. Two researchers independently coded the transcripts and field-notes prior to categorizing the codes and conducting a thematic analysis to identify required steps to EHR integration. The steps were reviewed and edited by the Epic technologist to ensure their accuracy.

Results:

Integrating the uterine fibroid Option Grid ™ PDA into clinician-facing menus required an 18-month timeline and a six-step process: (i) Negotiating task priority with Epic software teams; (ii) security risk assessment; (iii) technical review; (iv) Epic configuration; (v) troubleshooting; and (vi) launch. Key facilitators of the process were the clinical champions who advocated for the integration at the institutional level, the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard application platform (HL7 SMART on FHIR) as a means of integrating the Option GridTM into existing systems. This platform enabled clinicians to access the tools using single sign-on credentials and also prevented the Option GridTM tools from exposure to protected health information.

Conclusions:

Integration of PDAs into the Epic EHR system required a six-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance of an experienced technologist, and a willing EHR software developer team.