Background: Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and 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: This study aims to identify the steps and time required to integrate a PDA into the Epic EHR system and examine facilitators and barriers to the integration effort. Methods: We conducted a case study at 5 academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate the 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. The meetings were then recorded and transcribed. Two researchers independently coded the transcripts and field notes before categorizing the codes and conducting a thematic analysis to identify the facilitators and barriers to EHR integration. The steps were reviewed and edited by an 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 6-step process, as follows: task priority negotiation with Epic software teams, security risk assessment, technical review, Epic configuration; troubleshooting, and launch. The key facilitators of the process were the clinical champions who advocated for integration at the institutional level and the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard app platform (Health Level 7 Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources) as a means of integrating the Option Grid into existing systems. This standard platform enabled clinicians to access the tools by using single sign-on credentials and prevented protected health information from leaving the EHR. Key barriers were the lack of control over the Option Grid product developed by EBSCO (Elton B Stephens Company) Health; the periodic Epic upgrades that can result in a pause on new software configurations; and the unforeseen software problems with Option Grid (ie, inability to print the PDA), which delayed the launch of the PDA. Conclusions: The integration of PDAs into the Epic EHR system requires a 6-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance from an experienced technologist, and a willing EHR software developer team. Trial Registration:

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中文翻译：

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在 Epic 电子健康记录中集成 Option Grid 患者决策辅助工具：5 个医疗系统的案例研究

背景：一些研究人员认为，将患者决策辅助 (PDA) 成功实施到临床工作流程中取决于它们与电子健康记录 (EHR) 的集成。有趣的是，我们知道 EHR 集成是一项复杂且耗时的任务；然而，尚未详细审查该过程。作为实施项目的一部分，我们检查了将有症状的子宫肌瘤的遭遇 PDA 集成到 Epic EHR 系统中所涉及的工作。目标：本研究旨在确定将 PDA 集成到 Epic EHR 系统所需的步骤和时间，并检查集成工作的促进因素和障碍。方法：我们在美国的 5 个学术医疗中心进行了案例研究。每个机构的一名临床冠军与他们的 Epic EHR 团队联络，开始将子宫肌瘤 Option Grid PDA 整合到面向临床医生的菜单中。我们安排了与 Epic 软件分析师和 Epic 专家技术专家的定期会议，讨论如何最好地将这些工具集成到 Epic 中以供临床医生和患者使用。会议随后被记录和转录。两名研究人员在对代码进行分类和进行专题分析之前，独立对抄本和现场笔记进行编码，以确定 EHR 整合的促进因素和障碍。这些步骤由 Epic 技术专家审查和编辑，以确保其准确性。结果：将子宫肌瘤 Option Grid PDA 整合到面向临床医生的菜单中需要 18 个月的时间和 6 个步骤，如下所示：与 Epic 软件团队协商任务优先级、安全风险评估、技术审查、Epic 配置；故障排除，然后启动。该过程的主要推动者是倡导在机构层面进行整合的临床支持者，以及在构建过程中指导 Epic 软件分析师的经验丰富的技术专家。另一个推动因素是使用新兴的行业标准应用程序平台（Health Level 7 可替代医疗应用程序和快速医疗互操作性资源上的可重用技术）作为将 Option Grid 集成到现有系统的一种手段。该标准平台使临床医生能够使用单点登录凭证访问这些工具，并防止受保护的健康信息离开 EHR。主要障碍是缺乏对 EBSCO（Elton B Stephens Company）Health 开发的 Option Grid 产品的控制；可能导致新软件配置暂停的定期 Epic 升级；以及 Option Grid 无法预见的软件问题（即无法打印 PDA），延迟了 PDA 的发布。结论：将 PDA 集成到 Epic EHR 系统需要 6 个步骤的过程和 18 个月的时间表。该过程需要临床支持者的支持和优先排序、经验丰富的技术专家的指导以及愿意的 EHR 软件开发团队。试用注册：这推迟了 PDA 的推出。结论：将 PDA 集成到 Epic EHR 系统需要 6 个步骤的过程和 18 个月的时间表。该过程需要临床支持者的支持和优先排序、经验丰富的技术专家的指导以及愿意的 EHR 软件开发团队。试用注册：这推迟了 PDA 的推出。结论：将 PDA 集成到 Epic EHR 系统需要 6 个步骤的过程和 18 个月的时间表。该过程需要临床支持者的支持和优先排序、经验丰富的技术专家的指导以及愿意的 EHR 软件开发团队。试用注册：

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