ABSTRACT
INTRODUCTION: Integrating mobile applications (apps) into users' standard electronic health record (EHR) workflows may be valuable, especially for apps that both read and write data. This report details the lessons learned during the integration of a patient decision aid - prostate specific antigen (PSA) testing for prostate cancer screening - into our users' standard EHR workflow for a small usability assessment. MATERIALS AND METHODS: This feasibility study included two steps. First we enabled realtime, secure bidirectional data exchange between the mobile app and EHR for 14 data elements, and second we pilot tested the production environment app with 9 primary care patients aged 60-65 years. Our primary usability metric was a net promoter score (NPS), based on users' recommendation of the app to a friend or family member; we also assessed the proportion of users who 1) updated their prostate cancer risk factor information present in the EHR and 2) submitted more than one unique response regarding their preference to have PSA testing. RESULTS: The seven web services necessary to read and write data required considerable configuration, but successfully delivered risk factor-specific educational content and recorded patients' values and decision preference directly within the EHR. Seven of the 9 patients (78%) would recommend this app to a friend/family member (NPS = 55.6%), one patient used the app to update risk factor information, and 4/9 (44%) changed their decision preference while using the app. CONCLUSIONS: It is feasible to implement a decision aid directly into users' standard EHR workflow for limited usability testing. Broad scale implementation may have a positive effect on patient engagement and improve shared decision making, but several challenges exist with proprietary EHR vendor application programming interfaces (API)s.
