Supporting “shared decisionmaking” through health ITSkip to issue
§ 1. Benefits and challenges
Shared decisionmaking is a systematic approach to engaging patients in
- understanding the options they have in how to proceed with their care;
- exploring their preferences and values, along with the best medical evidence; and
- selecting an option after considering risks and benefits in a personal context.
Shared decisionmaking was first developed to help support conversations between provider and patient in life-threatening conditions. However, it can also work well for kinds of health care in which there are multiple options, and patients are able to choose one option over others. When evidence supports more than one approach, and the available treatment/testing options involve significant tradeoffs, a patient’s personal values and preferences should drive decisions.
As ONC policies and initiatives like Blue Button make health information more accessible, providers and individuals will require guidance on how to use technology to support shared decisionmaking. Providing that support will be an important focus of federal health IT efforts. Possible steps government could take are suggested below.
§ 2. Encouraging innovation
Using HealthIT.gov, the government could showcase “early adopters” of health IT and eHealth tools, as models of innovative ways that providers and patients are using health IT to select the most appropriate treatment options for the individual patient. Health IT can communicate the individual’s choice to other providers (such as specialists, pharmacists, and facilities where the individual receives care) so that additional care recognizes his/her preferences. This can avoid unnecessary or unwanted tests and treatments. Examples of this are: including an “advance directive” in a person’s health record, or noting that a certain drug had too many side effects for an individual to take.
- How can the federal government help providers engage in more opportunities for constructive shared decisionmaking?
- To encourage shared decisionmaking, would it be useful for the government to support development of such tools as decision aids, use cases, or reference libraries?
§ 3. Identifying trends
The government wants to identify trends in the health care market related to:
- shifting attitudes about individuals’ access to health information;
- how people can use this information to make better health care decisions and personally relevant care plans with their providers; and/or
- consumers’ and providers’ acceptance and use of health IT.
Identifying current trends in the health care market can help the government decide where and how to best intervene. The government could draw on ONC’s federal advisory committees or on Blue Button Pledge Program participants, provider champions within communities, and others to find this information.
- What trends are you seeing that will influence how patients and providers interact using technology?
§ 4. New regulations
The government could create new regulations or policies to promote shared decisionmaking through increased access to health information.
- What concerns do providers have about risk or risk sharing that cause them to limit their engagement in these information-sharing and decision processes, in order to avoid misunderstandings, poor health outcomes, or other potential problems?
- What policies have providers implemented in their practices that might serve as examples for how to address these concerns, and so promote more provider and patient engagement in shared decisionmaking through health IT?
- How can federal policies help maintain an appropriate division of responsibility for shared decisionmaking between providers and patients?
- Are there policies or activities where the federal government can help reduce risk for health IT and for developers who are creating decision aids for providers and patients to use in evaluating and selecting treatment options?
- What level of detail would be most useful in regulations to support new health IT products that promote shared decisionmaking?
For other discussions about the role federal regulation should play, see
§ 5. Privacy & security
(You can read the current version of Goal 3 by clicking the Background Documents tab at the top of this page, and selecting 2011-2015 Federal Health IT Strategic Plan).