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Search All Research Studies
Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Asthma (1)
- Cancer (1)
- Care Coordination (1)
- Caregiving (3)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (5)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (17)
- (-) Communication (40)
- Cultural Competence (2)
- Data (1)
- Diabetes (2)
- Diagnostic Safety and Quality (2)
- Disparities (1)
- Education: Patient and Caregiver (4)
- Elderly (3)
- (-) Electronic Health Records (EHRs) (40)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (1)
- Health Information Exchange (HIE) (3)
- Health Information Technology (HIT) (34)
- Health Literacy (3)
- Hospitals (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (2)
- Lifestyle Changes (1)
- Medication (3)
- Medication: Safety (2)
- Nursing (3)
- Outcomes (1)
- Palliative Care (1)
- Patient-Centered Healthcare (3)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (5)
- Patient Experience (3)
- Patient Safety (5)
- Policy (3)
- Primary Care (2)
- Provider (2)
- Provider: Clinician (2)
- Provider: Health Personnel (2)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
- Risk (1)
- Shared Decision Making (4)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 40 Research Studies DisplayedKandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communication, Provider: Clinician, Provider, Risk
Kelly MM, Smith CA, Hoonakker PLT
Stakeholder perspectives in anticipation of sharing physicians' notes with parents of hospitalized children.
Researchers sought to elicit stakeholder perspectives on the anticipated benefits and challenges of sharing hospital physicians' admission and daily progress notes with parents at the bedside during their child's hospitalization and to identify strategies to aid implementation of inpatient note sharing. Focus groups with 34 stakeholders at a children's hospital were conducted. The researchers identified four anticipated benefits of sharing inpatient notes, five expected challenges, and three suggested implementation strategies.
Citation: Kelly MM, Smith CA, Hoonakker PLT .
Stakeholder perspectives in anticipation of sharing physicians' notes with parents of hospitalized children.
Acad Pediatr 2021 Mar;21(2):259-64. doi: 10.1016/j.acap.2020.11.018..
Keywords: Children/Adolescents, Inpatient Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Clinician-Patient Communication
Rodriguez JA, Fossa A, Mishuris R
Bridging the language gap in patient portals: an evaluation of Google Translate.
Due to communication barriers, limited English-proficient (LEP) patients face challenges in the healthcare system. Given the language divide, the investigators sought to assess the use of Google Translate (GT) in the clinical setting and compare its efficacy to traditional human translation of patient messages. The investigators translated the messages to English using a professional translator and GT and created a series of clinical comprehension questions based on the message content.
AHRQ-funded; HS021495.
Citation: Rodriguez JA, Fossa A, Mishuris R .
Bridging the language gap in patient portals: an evaluation of Google Translate.
J Gen Intern Med 2021 Feb;36(2):567-69. doi: 10.1007/s11606-020-05719-z..
Keywords: Cultural Competence, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT)
Brown W, Balyan R, Karter AJ
Challenges and solutions to employing natural language processing and machine learning to measure patients' health literacy and physician writing complexity: the ECLIPPSE study.
In the National Library of Medicine-funded ECLIPPSE Project (Employing Computational Linguistics to Improve Patient-Provider Secure Emails exchange), the researchers attempted to create novel, valid, and scalable measures of both patients' health literacy (HL) and physicians' linguistic complexity by employing natural language processing techniques and machine learning. They identified 23 challenges and associated approaches that emerged from three overarching process domains. They suggested that investigators undertaking similar research in HL or using computational linguistic methods to assess patient-clinician exchange may find their solutions helpful when designing and executing health communications research.
Citation: Brown W, Balyan R, Karter AJ .
Challenges and solutions to employing natural language processing and machine learning to measure patients' health literacy and physician writing complexity: the ECLIPPSE study.
AHRQ-funded; HS026383..
Keywords: Health Literacy, Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Clinician-Patient Communication
Thate JA, Couture B, Schnock KO
Information needs and the use of documentation to support collaborative decision-making: implications for the reduction of central line-associated blood stream infections.
It is clear that interdisciplinary communication and collaboration have the potential to mitigate healthcare-associated harm, yet there is limited research on how communication through documentation in the patient record can support collaborative decision making. Understanding what information is needed to support collaborative decision making is necessary to design electronic health information systems that facilitate effective communication and, ultimately, safe care. To explore this issue, the investigators focused on information needs related to central venous catheter management and the prevention of central line-associated blood stream infections.
AHRQ-funded; HS0235335.
Citation: Thate JA, Couture B, Schnock KO .
Information needs and the use of documentation to support collaborative decision-making: implications for the reduction of central line-associated blood stream infections.
Comput Inform Nurs 2020 Nov 2;39(4):208-14. doi: 10.1097/cin.0000000000000683..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Shared Decision Making, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing
Rogith D, Satterly T, Singh H
Application of human factors methods to understand missed follow-up of abnormal test results.
This study demonstrated application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. The investigators identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. They analyzed transcribed responses, developed a CI-based flow model, and conducted a fault tree analysis to identify hierarchical relationships between factors that delayed action.
AHRQ-funded; HS022087; HS022901.
Citation: Rogith D, Satterly T, Singh H .
Application of human factors methods to understand missed follow-up of abnormal test results.
Appl Clin Inform 2020 Oct;11(5):692-98. doi: 10.1055/s-0040-1716537..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making, Diagnostic Safety and Quality, Communication, Clinician-Patient Communication
Singh H, Sittig DF
A sociotechnical framework for Safety-Related Electronic Health Record Research reporting: the SAFER Reporting Framework.
Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. This article proposed a methodological reporting framework for EHR interventions targeting patient safety and built on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology.
AHRQ-funded; HS022087; HS024459; HS017820.
Citation: Singh H, Sittig DF .
A sociotechnical framework for Safety-Related Electronic Health Record Research reporting: the SAFER Reporting Framework.
Ann Intern Med 2020 Jun 2;172(11 Suppl):S92-s100. doi: 10.7326/m19-0879..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Communication
Clarke MA, Fruhling AL, Sitorius M
Impact of age on patients' communication and technology preferences in the era of meaningful use: mixed methods study.
Impact of age on patients' communication and technology preferences in the era of meaningful use: mixed methods study.
AHRQ-funded; HS022110.
Citation: Clarke MA, Fruhling AL, Sitorius M .
Impact of age on patients' communication and technology preferences in the era of meaningful use: mixed methods study.
J Med Internet Res 2020 Jun;22(6):e13470. doi: 10.2196/13470..
Keywords: Elderly, Clinician-Patient Communication, Communication, Patient and Family Engagement, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ancker JS, Sharko M, Hong M
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
Parents routinely access young children's medical records, but medical societies strongly recommend confidential care during adolescence, and most medical centers restrict parental records access during the teen years. In this study, the investigators sought to assess public opinion about adolescent medical privacy. The investigators concluded that although medical societies recommend confidential care for adolescents, public opinion was largely in favor of parental access.
AHRQ-funded; HS021531.
Citation: Ancker JS, Sharko M, Hong M .
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
J Am Med Inform Assoc 2018 Dec;25(12):1593-99. doi: 10.1093/jamia/ocy120..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Senft N, Butler E, Everson J
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
This study examined trends in eHealth disparities before and after the introduction of US federal financial incentives. The investigators compared rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. The investigators concluded that disparities in provider messaging widened over time, particularly following federal financial incentives.
AHRQ-funded; HS26395; HS26122.
Citation: Senft N, Butler E, Everson J .
Growing disparities in patient-provider messaging: trend analysis before and after supportive policy.
J Med Internet Res 2019 Oct 7;21(10):e14976. doi: 10.2196/14976..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Disparities, Clinician-Patient Communication, Communication, Policy
Quinn M, Forman J, Harrod M
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created challenges and opportunities for such communication. In this multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals, the investigators found that existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making.
AHRQ-funded; HS022835; HS024385.
Citation: Quinn M, Forman J, Harrod M .
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis 2019 Aug 27;6(3):241-48. doi: 10.1515/dx-2018-0036.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Communication
Grout RW, Cheng ER, Aalsma MC
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
This study examined the effect of an automated alert during electronic pre-visit electronic tablet screening on the adolescent self-report rate at pediatric ambulatory clinics. The goal was to increase self-reporting as opposed to parents or caregivers filling out the screening information.bAn interventional study was conducted over a 16 month period. Preintervention rates were low for adolescents, with parents or caregivers completing the pre-visit reports at a high rate. After intervention, self-reporting by younger adolescents nearly doubled and among older adolescents the stable baseline rate of 53.6% increased by 9.2 absolute percentage points.
AHRQ-funded; HS017939; HS018453; HS020640; HS022681.
Citation: Grout RW, Cheng ER, Aalsma MC .
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
Acad Pediatr 2019 Jul;19(5):581-88. doi: 10.1016/j.acap.2019.04.010..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Communication, Clinician-Patient Communication
Patel MR, Friese CR, Mendelsohn-Victor K
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
This study examined the effects of electronic health records (EHRs) on communication and patient safety in oncology practices. The authors conducted a survey of 297 oncology nurses and prescribers in a statewide collaborative. They found there was an inverse relationship between reliance on EHRs and safety.
AHRQ-funded; HS024914.
Citation: Patel MR, Friese CR, Mendelsohn-Victor K .
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
J Oncol Pract 2019 Jun;15(6):e529-e36. doi: 10.1200/jop.18.00507..
Keywords: Cancer, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Clinician
Patel MR, Smith A, Leo H
Improving patient-provider communication and therapeutic practice through better integration of electronic health records in the exam room: a pilot study.
This study assessed the effectiveness of providing physicians who use electronic health records (EHRs) education for communication strategies and its impact on patient outcomes. The evidence-based Physician Asthma Care Education (PACE) program was extended in a pilot program using 18 providers and 126 adult patients with persistent asthma. Outcomes were assessed at baseline and 3- and 6-month postintervention intervals. Providers who completed the EHR-PACE program felt more confident in communicating with their patients, but there was no significant changes in patient asthma outcomes or their perceptions of their provider’s communication skills.
AHRQ-funded; HS023786.
Citation: Patel MR, Smith A, Leo H .
Improving patient-provider communication and therapeutic practice through better integration of electronic health records in the exam room: a pilot study.
Health Educ Behav 2019 Jun;46(3):484-93. doi: 10.1177/1090198118796879..
Keywords: Asthma, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Evidence-Based Practice, Health Information Technology (HIT), Outcomes, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Khoong EC, Cherian R, Matta GY
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
The goal of this study was to understand how safety-net patients, including those with limited English proficiency, view clinician electronic health record (EHR) use. Through focus groups in English, Spanish, and Cantonese, results showed that linguistically diverse patients accepted the value of EHR use during outpatient visits but desired more eye contact, verbal warnings before EHR use, and screen-sharing. Support for clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients is recommended.
AHRQ-funded; HS022561; HS023558; HS022408.
Citation: Khoong EC, Cherian R, Matta GY .
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
J Med Internet Res 2019 May 22;21(5):e13131. doi: 10.2196/13131..
Keywords: Cultural Competence, Racial and Ethnic Minorities, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Health Literacy, Communication
Asan O, Scanlan MC, Crotty B
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
The objective of this study was to explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. The investigators suggest that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but also note potential drawbacks.
AHRQ-funded; HS023626.
Citation: Asan O, Scanlan MC, Crotty B .
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
Pediatr Crit Care Med 2019 May;20(5):435-41. doi: 10.1097/pcc.0000000000001895..
Keywords: Caregiving, Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Intensive Care Unit (ICU), Patient and Family Engagement
Son H, Nahm ES
Older adults' experience using patient portals in communities: challenges and opportunities.
The purpose of this study was to assess the perceived usability of patient portals currently used by older adults. 272 older adults were recruited from an online trial testing the effects of a 3-week Theory-Based Patient Portal eLearning Program. Self-efficacy and perceived usability of patient portals were both low; difficulties with using patient portals were primarily associated with login/access and specific portal functions. Favored features were review of medical information and eMessaging.
AHRQ-funded; HS024739.
Citation: Son H, Nahm ES .
Older adults' experience using patient portals in communities: challenges and opportunities.
Comput Inform Nurs 2019 Jan;37(1):4-10. doi: 10.1097/cin.0000000000000476..
Keywords: Clinician-Patient Communication, Communication, Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Web-Based
Sieck CJ, Walker DM, Hefner JL
Understanding secure messaging in the inpatient environment: a new avenue for communication and patient engagement.
Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. In this study, the investigators analyzed and categorized messages sent within an inpatient portal to understand the topics discussed in secure messaging in the inpatient environment. They concluded that their analysis of secure message content suggested certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans were particularly important to patients.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Sieck CJ, Walker DM, Hefner JL .
Understanding secure messaging in the inpatient environment: a new avenue for communication and patient engagement.
Appl Clin Inform 2018 Oct;9(4):860-68. doi: 10.1055/s-0038-1675814..
Keywords: Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Inpatient Care, Patient and Family Engagement
Bush RA, Perez A, Baum T
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
In this study, a systematic review, was conducted, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999 - 2017 of human subject peer-reviewed articles in English containing original research about the electronic health record and palliative care. The review identified five major areas in which the EHR is used to support PC.
AHRQ-funded; HS022404.
Citation: Bush RA, Perez A, Baum T .
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
JAMIA Open 2018 Oct 1;1(2):294-303. doi: 10.1093/jamiaopen/ooy028..
Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Palliative Care
Barbieri AL, Fadare O, Fan L
Challenges in communication from referring clinicians to pathologists in the electronic health record era.
This study reports on the role played by electronic health record inbox messages (EHRmsg) in a safety event involving pathology. Clinicians assumed that pathologists used EHRmsg as clinical care team members, however, pathologists rarely did. Communication gaps exist between primary clinicians and pathologists in the EHR era and they have potential to result in patient harm.
AHRQ-funded; HS022087.
Citation: Barbieri AL, Fadare O, Fan L .
Challenges in communication from referring clinicians to pathologists in the electronic health record era.
J Pathol Inform. 2018 Apr 2;9:8. doi: 10.4103/jpi.jpi_70_17..
Keywords: Adverse Events, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Benda N, Hettinger A, Bisantz A
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
This study described the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. It found that physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas.
AHRQ-funded; HS022542.
Citation: Benda N, Hettinger A, Bisantz A .
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
Journal of Healthcare Informatics Research 2017 Dec;1(2):218-30.
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Keywords: Communication, Electronic Health Records (EHRs), Provider: Health Personnel, Emergency Department, Nursing
Chung S, Panattoni L, Chi J
Can secure patient-provider messaging improve diabetes care?
The authors examined whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. Patients with diabetes using an online portal were studied; 72% used messaging, and those who made frequent visits were also more likely to message. No messaging at all was negatively associated with the likelihood of meeting an HbA1c target. Among message users, additional messages were associated with better outcome, with a stronger relationship for noninsulin users. Physician-initiated messages had effects similar to those for patient-initiated messages.
AHRQ-funded; HS019815.
Citation: Chung S, Panattoni L, Chi J .
Can secure patient-provider messaging improve diabetes care?
Diabetes Care 2017 Oct;40(10):1342-48. doi: 10.2337/dc17-0140.
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Keywords: Communication, Diabetes, Clinician-Patient Communication, Electronic Health Records (EHRs)
Ancker JS, Send A, Hafeez B
Health IT usability focus section: adapting EHR-based medication instructions to comply with plain language guidance-a randomized experiment.
Using examples of clinician-written medication instructions from an electronic health record, the investigators conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language. The researchers found that a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions.
AHRQ-funded; HS021531.
Citation: Ancker JS, Send A, Hafeez B .
Health IT usability focus section: adapting EHR-based medication instructions to comply with plain language guidance-a randomized experiment.
Appl Clin Inform 2017 Oct;8(4):1127-43. doi: 10.4338/aci-2017-06-ra-0111..
Keywords: Communication, Education: Patient and Caregiver, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Brown SD, Grijalva CS, Ferrara A
Leveraging EHRs for patient engagement: perspectives on tailored program outreach.
Electronic health records (EHRs) present healthcare delivery systems with scalable, cost-effective opportunities to promote lifestyle programs among patients at high risk for type 2 diabetes, yet little consensus exists on strategies to enhance patient engagement. In this study, the investigators explored patient perspectives on program outreach messages containing content tailored to EHR-derived diabetes risk factors--a theory-driven strategy to increase the persuasiveness of health communications.
AHRQ-funded; HS019367.
Citation: Brown SD, Grijalva CS, Ferrara A .
Leveraging EHRs for patient engagement: perspectives on tailored program outreach.
Am J of Manag Care 2017 Jul;23(7):e223-e30..
Keywords: Diabetes, Communication, Education: Patient and Caregiver, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Lifestyle Changes, Patient and Family Engagement
Zikmund-Fisher BJ, Scherer AM, Witteman HO
Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results.
Most electronic health record systems provide laboratory test results to patients in table format. Researchers tested whether presenting such results in visual displays (number lines) could improve understanding. They found that visual displays reduced respondents' perceived urgency and desire to contact health care providers immediately for near-normal test results compared to tables but did not affect their perceptions of extreme values.
AHRQ-funded; HS021681.
Citation: Zikmund-Fisher BJ, Scherer AM, Witteman HO .
Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results.
J Am Med Inform Assoc 2017 May 1;24(3):520-28. doi: 10.1093/jamia/ocw169.
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Keywords: Communication, Education: Patient and Caregiver, Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT)