title: Integrating data from an online diabetes prevention program into an electronic health record and clinical workflow, a design phase usability study.
abstract: Health information is increasingly being digitally stored and exchanged. The public is regularly collecting and storing health-related data on their own electronic devices and in the cloud. Diabetes prevention is an increasingly important preventive health measure, and diet and exercise are key components of this. Patients are turning to online programs to help them lose weight. Despite primary care physicians being important in patients' weight loss success, there is no exchange of information between the primary care provider (PCP) and these online weight loss programs. There is an emerging opportunity to integrate this data directly into the electronic health record (EHR), but little is known about what information to share or how to share it most effectively. This study aims to characterize the preferences of providers concerning the integration of externally generated lifestyle modification data into a primary care EHR workflow.
  
  
  
  We performed a qualitative study using two rounds of semi-structured interviews with primary care providers. We used an iterative design process involving primary care providers, health information technology software developers and health services researchers to develop the interface.
  
  
  
  Using grounded-theory thematic analysis 4 themes emerged from the interviews: 1) barriers to establishing healthy lifestyles, 2) features of a lifestyle modification program, 3) reporting of outcomes to the primary care provider, and 4) integration with primary care. These themes guided the rapid-cycle agile design process of an interface of data from an online diabetes prevention program into the primary care EHR workflow.
  
  
  
  The integration of external health-related data into the EHR must be embedded into the provider workflow in order to be useful to the provider and beneficial for the patient. Accomplishing this requires evaluation of that clinical workflow during software design. The development of this novel interface used rapid cycle iterative design, early involvement by providers, and usability testing methodology. This provides a framework for how to integrate external data into provider workflow in efficient and effective ways. There is now the potential to realize the importance of having this data available in the clinical setting for patient engagement and health outcomes.
authors.affiliation: Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2nd floor, Boston, MA, 02118, USA. rgrochow@bu.edu.
authors.forename: Rebecca Grochow
authors.initials: RG
authors.lastname: Mishuris
authors.affiliation: Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2nd floor, Boston, MA, 02118, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Yoder
authors.affiliation: Moxe Health, Madison, Wisconsin, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2nd floor, Boston, MA, 02118, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Mann
mesh_terms: D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus / Q000517:prevention & control*; D057286:Electronic Health Records; D006282:Health Personnel; D006801:Humans; D011320:Primary Health Care; D036301:Qualitative Research; D057188:Workflow
keywords: Clinical decision support; Electronic health record; Preventive medicine; Usability testing; e-health