Fostering Shared Decision-Making through the use of Electronic Health Records

Shared decision-making (SDM) in healthcare is considered a gold standard for supporting the cooperation of physicians and patients. Despite various positive outcome-relevant effects, the practice of engaging patients in their healthcare decisions is infrequently implemented in routine care. In addition to some system-level characteristics there are organizational characteristics that influence SDM implementation. One strategy focusing on the organizational level to support SDM is the use of electronic health records (EHR).

SDM is a process by which a healthcare provider and a patient jointly make a health decision after discussing different treatment options, their potential benefits and health risks, and considering the patient’s values and preferences. This process is challenging when patients lack information about their health problems and the pros and cons of various treatment options. Acknowledging and supporting the patient resolves this barrier and can help foster an informed, shared decision about the best disease management strategy.

Providing reliable and evidence-based health information

National health information portals, provided by government funded organizations, have an excellent opportunity to be a central point of contact for health issues. Such portals can support patients in making informed decisions by providing reliable and evidence-based information. In countries like Denmark and Austria, the EHR is connected to health information portals. This connection offers the potential to interlink general health information with patients’ individual health data along their course of treatment. By clicking on an “info” button displayed with the patients’ health data (e.g. laboratory results), the patient is directed to corresponding, easily understandable information within the health information portal. In the same way, it would be of great benefit if the entry of a specific diagnosis in an EHR is linked with disease-related information recommended by physicians. This information should also include decision aids that facilitate patient participation in healthcare decisions by providing information about the treatment options and their associated outcomes (benefits and harms). This allows patients to review possible options by clarifying personal values. By ensuring that the patient is well informed about his/her disease and the different treatment options, the patient can better participate in a shared decision-making process and take more responsibility for his/her health.

The use of EHR in the SDM process

An EHR can support SDM at every stage of the process. Lenert et al. discuss a four-phase conceptual model to integrate the SDM process into clinical workflows. A possible process might look like this: In the first phase “Initiate SDM”, EHR can use an alert system when there is a context for preference sensitive care. In that way, the EHR alert helps a provider recognize and respond to a context requiring SDM. In the second phase “Discuss Options”, the provider can use the EHR to send an order for the use of a decision aid (that might be provided by the health information portal including further disease-specific information, see above). The patient receives a reminder showing that he/she has a task to complete in his/her patient portal account. This can be done either during a patient visit or at home, with other family members if desired. After filling out the decision aid including a value clarification exercise, the data would be presented back to the provider. In the third phase “Make a Decision”, the provider can access the results of the patient´s preferences of the different treatment options. After that, the patient and the provider together deliberate on the best option for care. In the last phase “Monitor & Follow-up”, so called “agents” that run within an EHR can detect situations where treatment conflicts with patient preferences. Hereby, ongoing monitoring of care can ensure treatments are consistent with patient´s preferences.

Nevertheless, it is particularly important to emphasize that EHR should not replace the doctor-patient interaction but facilitate this interaction by providing information in a timely manner.