Foraker Randi E, Kite Bobbie, Kelley Marjorie M, Lai Albert M, Roth Caryn, Lopetegui Marcelo A, Shoben Abigail B, Langan Michael, Rutledge Nicole L, Payne Philip R O
The Ohio State University.
EGEMS (Wash DC). 2015 Jun 18;3(2):1159. doi: 10.13063/2327-9214.1159. eCollection 2015.
Electronic health records (EHRs) have the potential to enhance patient-provider communication and improve patient outcomes. However, in order to impact patient care, clinical decision support (CDS) and communication tools targeting such needs must be integrated into clinical workflow and be flexible with regard to the changing health care landscape.
The Stroke Prevention in Healthcare Delivery Environments (SPHERE) team developed and implemented the SPHERE tool, an EHR-based CDS visualization, to enhance patient-provider communication around cardiovascular health (CVH) within an outpatient primary care setting of a large academic medical center.
We describe our successful CDS alert implementation strategy and report adoption rates. We also present results of a provider satisfaction survey showing that the SPHERE tool delivers appropriate content in a timely manner. Patient outcomes following implementation of the tool indicate one-year improvements in some CVH metrics, such as body mass index and diabetes.
Clinical decision-making and practices change rapidly and in parallel to simultaneous changes in the health care landscape and EHR usage. Based on these observations and our preliminary results, we have found that an integrated, extensible, and workflow-aware CDS tool is critical to enhancing patient-provider communications and influencing patient outcomes.
电子健康记录（EHRs）有潜力加强患者与医疗服务提供者之间的沟通并改善患者治疗效果。然而，为了对患者护理产生影响，针对此类需求的临床决策支持（CDS）和沟通工具必须整合到临床工作流程中，并且要能灵活适应不断变化的医疗保健环境。
医疗服务提供环境中的卒中预防（SPHERE）团队开发并实施了SPHERE工具，这是一种基于电子健康记录的临床决策支持可视化工具，用于在一家大型学术医疗中心的门诊初级护理环境中加强患者与医疗服务提供者围绕心血管健康（CVH）的沟通。
我们描述了成功的临床决策支持警报实施策略并报告了采用率。我们还展示了一项医疗服务提供者满意度调查的结果，表明SPHERE工具能及时提供恰当的内容。该工具实施后的患者治疗效果显示，在一些心血管健康指标上有了一年期的改善，如体重指数和糖尿病情况。
临床决策和实践变化迅速，与医疗保健环境和电子健康记录使用的同步变化并行。基于这些观察结果和我们的初步结果，我们发现一个集成的、可扩展的且了解工作流程的临床决策支持工具对于加强患者与医疗服务提供者的沟通以及影响患者治疗效果至关重要。
