Effectiveness and Implementation of mPATH-CRC: a Mobile Health System for Colorectal Cancer Screening

mPATH-CRC 的有效性和实施：用于结直肠癌筛查的移动医疗系统

• 批准号: 10165873
• 负责人: David P Miller
• 金额: $ 22万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165873
• 关键词: Administrative Supplement; Administrator; Adopted; Architecture; Authorization documentation; Award; COVID-19; Caring; Clinic; Clinical; Cloud Computing; Colorectal Cancer; Communities; Computer software; Data; Data Science; Dependence; Development; Effectiveness; Electronic Health Record; Engineering; Environment; Guidelines; Health; Health Technology; Health system; Healthcare; Healthcare Systems; Industry Standard; Information Systems; Intervention; Literature; Mediating; Mobile Health Application; Modeling; Parents; Patients; Process; Production; Publishing; Qualitative Research; Randomized Controlled Trials; Research; Resources; Role; Screening for cancer; Secure; Security; Services; Strategic Planning; System; Technology; Testing; Translating; United States National Institutes of Health; Vendor; Work; application programming interface; base; cloud based; colorectal cancer screening; data exchange; data modeling; data standards; digital; effectiveness implementation study; effectiveness trial; experience; forest; health care delivery; health care settings; health management; improved; interoperability; mHealth; migration; open data; programs; software development; software infrastructure; success; uptake; working group

Abstract As outlined in the NIH Strategic Plan for Data Science, recent advances in computing technology have improved the ability to create interoperable and scalable electronic health record (EHR) integrated software using WebServices (e.g., application programming interfaces, APIs) and cloud-based computing architecture. The current leading standard for health care data exchange is Fast Health Interoperability Resources (FHIR), published by the HL7® working group. FHIR is a specification that provides standardized data models and APIs for managing health care data, and represents a simplification and expansion of earlier HL7 standards. The SMART on FHIR standard allows the integration of apps within a clinical workflow, including contextual embedding, authorization, and single sign-on. As technology evolves, EHRs have increasingly adopted more of a platform role, enabling third-party applications to perform limited functions within the system of record. Interoperable standards-based information systems that facilitate the secure but agile exchange of data are critical to contemporary healthcare delivery. Cloud-based services are widely used in the non-healthcare domain. EHR-integrated digital and mobile health applications must include expanded use of the SMART on FHIR standard and cloud base architecture to allow for scalability and ease of installation across healthcare systems and care settings. Our team, which includes board-certified clinical informaticists and Epic-certified programmers, has deep expertise creating multilevel digital health interventions that target the patient, clinician, and healthcare system to increase the uptake of guideline-recommended cancer screening. In a prior multisite randomized controlled trial, our highly successful mPATHTM-CRC (mobile PAtient Technology for Health-Colorectal Cancer) iPad app doubled the proportion of patients who were screened for colorectal cancer. We are currently conducting a hybrid implementation- effectiveness trial of mPATHTM-CRC in 28 community-based clinics (R01CA218416-A1). As part of the parent award, we determined the best way to integrate mPATHTM-CRC in clinical workflow. We then spent 9 months converting mPATHTM- CRC from a stand-alone iPad app to one that is fully-integrated with Wake Forest’s Epic EHR. To date, we have launched the new EHR-integrated mPATHTM program in 6 of our planned 28 clinics. Prior to COVID-19, over 15,000 patients had used mPATHTM, which identified over 1100 patients who were overdue for CRC screening by a mean of 10 years. The specific aims of this supplement are to: (1) Enhance the mPATHTM-CRC application’s interoperability and decrease EHR- vendor specific dependencies by leveraging WebServices and SMART on FHIR; (2) re-engineer mPATHTM-CRC from a containerized, on-premise architecture to a service-agnostic cloud-based architecture; and (3) validate the interoperable (SMART on FHIR leveraging OAUTH2.0) and cloud-based architecture through rigorous testing. Achieving these aims will greatly increase the impact of the platform and contribute to the literature for open-standards based software development. Additionally, this project will yield essential information for the successful implementation of other technology-mediated interventions in healthcare settings.

抽象的 正如 NIH 数据科学战略计划中所述，计算技术的最新进展提高了 使用 Web 服务创建可互操作且可扩展的电子健康记录 (EHR) 集成软件的能力 （例如，应用程序编程接口、API）和基于云的计算架构。 用于医疗保健数据交换的是快速健康互操作性资源 (FHIR)，由 HL7® 工作组发布。 FHIR 是一种规范，提供用于管理医疗保健数据的标准化数据模型和 API，代表了 SMART on FHIR 标准的简化和扩展允许在其中集成应用程序。 临床工作流程，包括上下文嵌入、授权和单点登录 随着技术的发展，EHR 已经实现了。 越来越多地采用平台角色，使第三方应用程序能够在平台内执行有限的功能 可互操作的基于标准的信息系统，促进安全而敏捷的信息交换。 数据对于当代医疗保健服务至关重要基于云的服务广泛应用于非医疗保健领域。 EHR 集成数字和移动医疗应用程序必须包括在 FHIR 上扩展 SMART 的使用。 标准和云基础架构，可实现跨医疗保健系统和护理的可扩展性和易于安装 我们的团队包括经过委员会认证的临床信息学家和 Epic 认证的程序员，拥有深厚的背景。 专业知识创建多层次的数字健康干预措施，针对患者、临床医生和医疗保健系统 在之前的多中心随机对照试验中，增加了指南推荐的癌症筛查的采用率。 非常成功的 mPATHTM-CRC（移动患者健康技术 - 结直肠癌）iPad 应用程序使 我们目前正在进行一项混合实施—— mPATHTM-CRC 在 28 个社区诊所进行的有效性试验 (R01CA218416-A1) 作为家长奖励的一部分，我们。 确定了将 mPATHTM-CRC 集成到临床工作流程中的最佳方法，然后我们花了 9 个月的时间转换 mPATHTM-。 CRC 从一款独立的 iPad 应用程序到与维克森林大学的 Epic EHR 完全集成的应用程序 迄今为止，我们已经推出了。 在 COVID-19 之前，我们计划在 28 家诊所中的 6 家实施新的 EHR 集成 mPATHTM 计划，已有超过 15,000 名患者接受过治疗。 使用 mPATHTM，它发现了超过 1100 名平均逾期 10 年才进行 CRC 筛查的患者。 本补充的具体目标是： (1) 增强 mPATHTM-CRC 应用程序的互操作性并减少 EHR- 通过利用 FHIR 上的 WebServices 和 SMART 来重新设计 mPATHTM-CRC； 容器化的本地架构到与服务无关的基于云的架构；(3) 验证可互操作性； （SMART on FHIR 利用 OAUTH2.0）和基于云的架构将通过严格的测试实现这些目标。 极大地提高了平台的影响力，并为基于开放标准的软件文献做出了贡献 此外，该项目将为其他项目的成功实施提供重要信息。 医疗保健环境中以技术为媒介的干预措施。