1. Using Information Technology to Evaluate Shared Decision Making in a Clinical Setting Stephen Kearing 1, Kate Clay 2, Lisa Maheu 2, E. Dale Collins 3, Caroline Moore 3, Hilary Llewellyn-Thomas 1, Annette O’Connor 4, Susan Gallagher 5, Kristen Chambers 5, and David Aman 5 1 Center for Evaluative Clinical Sciences, Dartmouth Medical School, 2 Center for Shared Decision Making, 3 Comprehensive Breast Program, Dartmouth Hitchcock Medical Center, 4 Ottawa Health Research Institute, University of Ottawa, 5 BioInformatics, Dartmouth Medical School Background Conclusions Using standard software and hardware, the Center for Shared Decision Making currently uses two distinct applications. 1)The CSDM database (CenterWorks) resides on a Microsoft SQL server® and is generic in scope. It captures patients’ demographic characteristics and visit information, decision services provided, stage and preferred role, treatment predispositions, decisional conflict, preparation for decision making, and satisfaction. 2)The Comprehensive Breast Program (CBP) / Center for Shared Decision Making joint project use a web-based system. In this study, longitudinal assessments of medical as well as decision-making data are captured for breast cancer patients. Online processing allows for immediate scoring and automatic interventions for patients scoring above designated thresholds. Methods The purpose of the Center for Shared Decision Making (CSDM) at Dartmouth-Hitchcock Medical Center (DHMC) is to provide patients with decision support. An effective decision support service in a busy clinical setting requires information systems that can meet the unique needs of multiple players: The patient/provider dyad needs to record and summarize an individual’s clinical and decisional data. Clinical staff and researchers need a system that permits rapid aggregation and analysis of cohort data. The institution that houses the service needs performance measures that can contribute to overall monitoring and quality- assurance. Objective To demonstrate the computer-based systems used by the CSDM to address these information management and reporting needs. The information-system technology for integrating Shared Decision Making and clinical care currently exists. The emergent data can yield valuable insights into the patient decision making process, the clinical skills involved in decision support, and the achievement of performance standards. The principles used to guide the design and implementation of the CSDM’s electronic information system can be adapted for other clinical shared-decision making initiatives. 1) Generic Decision Support at CSDM 2) Decision Support for Breast Cancer  Patient Flow Positive breast biopsy Schedule appointments 1) decision support 2) surgery consult Patient watches video and completes questionnaire Patient Flow Patients are clinician- or self- referred to the Center for: Decision support Decision aid (DA) Information After decision support, patients complete questionnaires about: Decision Process Decision Quality DA Acceptability Satisfaction Summary reports monitor and evaluate Center performance  System front End Staff and patients enter data and access reports through a secure website  Back End Sybase ® server stores clinical and decision support data Summary reports track the cohort enrolled in the Breast Program Questionnaire is scored immediately Automatic referrals to Breast Care Coordinator/ Familial Cancer Program when patients score above clinical thresholds Patient is contacted same day in person or later by phone Copy entered into patient electronic medical record Financial support for these projects was provided by the Foundation for Informed Medical Decision Making (www.fimdm.org) Print patient report Individual reports allow patients to record decision progress Breast program patient proceeds to surgery consultation with her report Results These systems provide - feedback of clinical and decision process data in real time at the individual level an accessible source of data for research and clinical reporting System front end Staff enter data and access reports from secure network PCs Back end SQL server ® captures Patient visit, DA circulation, Center activity data