Abstract
BackgroundThe COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care.ObjectiveTo provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation.MethodsWe first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted.ResultsWe have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content.ConclusionsIt is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.
Highlights
Besides inadequate personal protective equipment and limited intensive care surge capacity, the COVID-19 pandemic has shined a harsh light on another critical deficiency in our system of health care delivery: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR) [1,2,3]
All over the United States, frontline clinicians in the field, emergency departments, intensive care units (ICUs), and on rapid response teams and hospital floors have struggled with urgent decisions about the use of life-supporting technologies to treat serious complications of COVID-19 infection without sufficient information about the patient as a person, what means most to this individual, how the patient defines living well, and whom the patient trusts to make important decisions about health care [4,5]
The Patient Values Tab will be accessible to all health care team members across the spectrum of patient care. One such principle was that the tab would be in a read-only display format, populated with existing source documents in the EHR that could not be directly edited in the tab itself. We chose this approach because we and various key stakeholders we interviewed were concerned that the content would become unwieldy and unstable, leading to inefficiency for users if multiple modifications were allowed
Summary
BackgroundBesides inadequate personal protective equipment and limited intensive care surge capacity, the COVID-19 pandemic has shined a harsh light on another critical deficiency in our system of health care delivery: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR) [1,2,3]. All over the United States, frontline clinicians in the field, emergency departments, intensive care units (ICUs), and on rapid response teams and hospital floors have struggled with urgent decisions about the use of life-supporting technologies to treat serious complications of COVID-19 infection without sufficient information about the patient as a person, what means most to this individual, how the patient defines living well, and whom the patient trusts to make important decisions about health care [4,5] Such information is rarely accessible even for older adults and others with underlying diseases, such as cancer or chronic comorbid conditions, who are most vulnerable. Health care providers use a structured template to document their discussions of patient goals of care
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