UCSF

OBJECTIVE: Despite interest in optimizing the electronic health record (EHR) to facilitate chronic disease care for conditions like rheumatoid arthritis (RA), progress in this area has been slow. EHR sidecar applications offer one solution, but little guidance exists to facilitate their successful development, deployment, and maintenance in the healthcare setting. We aimed to provide a roadmap for how to develop and deploy an EHR sidecar application based on our experience building a new EHR-integrated, patient-facing visualization tool that displayed disease outcomes to RA patients during a clinical visit (the RA PRO dashboard) in a large academic health center. METHODS: We describe the technical design and implementation of the RA PRO dashboard; report clinic workflow adaptations to incorporate this new technology; and discuss the resources required and challenges encountered in maintaining this application. RESULTS: The RA PRO dashboard required extensive human-centered design work, regulatory approvals, software development, user testing, integration with Epic-based workflows, and maintenance. Key requirements were prioritized based on the anticipated effects on usefulness and ease of use. Implementation science strategies were used to improve use of the dashboard in clinic and included education for patients, staff, and clinicians; reports of actual use of the dashboard and data quality; and regular meetings between the research team and clinicians to discuss and address barriers to use. CONCLUSION: Successful development and deployment of an EHR-integrated application are resource-intensive and require technical, operational, and educational innovations. The roadmap presented in this study can serve as a resource for future developers.