from smartphone to ehr: a case report on integrating patient-generated health data

Is there an evidence-based guide to integrate patient-generated digital health data?

This research, led by Oregon Health & Science University, will support the development of an evidence-based practical guide on integrating patient-generated digital health data for ambulatory care practices. The team will first conduct an environmental scan that includes a literature review and input from stakeholders.

Can ambulatory care practices use electronic health records (EHRs) effectively?

While these technologies are promising, the ability for ambulatory care practices to successfully collect these data in collaboration with patients, transfer data to their electronic health records (EHRs), and use them effectively in clinics poses many challenges.

What is patient-generated health data?

Patient-generated health data are “health-related data created, recorded, or gathered by or from patients (or family members or other caregivers) to help address a health concern.”

What is PGHD in EHR?

Patient-generated health data (PGHD), collected from mobile apps and devices, represents an opportunity for remote patient monitoring and timely interventions to prevent acute exacerbations of chronic illness—if data are seen and shared by care teams. This case report describes the technical aspects of integrating data from a popular smartphone platform to a commonly used EHR vendor and explores the challenges and potential of this approach for disease management. Consented subjects using the Asthma Health app (built on Apple’s ResearchKit platform) were able to share data on inhaler usage and peak expiratory flow rate (PEFR) with a local pulmonologist who ordered this data on Epic’s EHR. For users who had installed and activated Epic’s patient portal (MyChart) on their iPhone and enabled sharing of health data between apps via HealthKit, the pulmonologist could review PGHD and, if necessary, make recommendations. Four patients agreed to share data with their pulmonologist, though only two patients submitted more than one data point across the 4.5-month trial period. One of these patients submitted 101 PEFR readings across 65 days; another submitted 24 PEFR and inhaler usage readings across 66 days. PEFR for both patients fell within predefined physiologic parameters, except once where a low threshold notification was sent to the pulmonologist, who responded with a telephone discussion and new e-prescription to address symptoms. This research describes the technical considerations and implementation challenges of using commonly available frameworks for sharing PGHD, for the purpose of remote monitoring to support timely care interventions.

What are the benefits of mHealth apps?

mHealth apps and wearable health devices have become increasingly popular among consumers, providing a convenient method of tracking and monitoring fitness, diet, and sleep . 1 Frequent sampling of objective data such as heart rate and rhythm, 2 blood pressure, 3 blood glucose, 4, 5 oxygen saturation, 6 and activity 7 for research or clinical care outside of periodic health-care visits is now feasible, and in some cases smartphone apps and related devices have earned US Food and Drug Administration approval and use in clinical workflows. 8 Moreover, subjective data including standardized surveys or other questionnaires assessing symptoms and other patient-reported outcomes can also be efficiently captured. The ability to collect, summarize, and integrate this data into electronic medical records may facilitate research and clinical care by providing a more nuanced and accurate assessment of health status outside of the typical brief clinical visit or research visit. 9, 10, 11

What is HealthKit?

In 2014, Apple launched HealthKit, a common framework for developers to share patient-generated health data (PGHD) among apps, services, and providers. 12 ResearchKit, launched in 2015, is an open source framework that gives investigators the infrastructure to develop mobile applications for research via mobile phones.

Can Bluetooth devices be shared?

Data from Bluetooth devices could be thus voluntarily shared by the participant for both research purposes and clinical purposes (these types of external devices were not used in the current study, however). Even when technical hurdles are overcome, however, processing and acting on incoming PGHD need to be addressed.

Can Healthkit be used for personal use?

Otherwise, a patient’s HealthKit data could only be used for personal purposes, or shared with a provider if desired, by connecting with MyChart. To then transmit research that data to a clinician, there would need to be communication between the app’s underlying ResearchKit framework, HealthKit, and the MyChart app.

What is PGHD in EHR?

Patient-generated health data (PGHD), collected from mobile apps and devices, represents an opportunity for remote patient monitoring and timely interventions to prevent acute exacerbations of chronic illness-if data are seen and shared by care teams. This case report describes the technical aspects of integrating data from a popular smartphone platform to a commonly used EHR vendor and explores the challenges and potential of this approach for disease management. Consented subjects using the Asthma Health app (built on Apple's ResearchKit platform) were able to share data on inhaler usage and peak expiratory flow rate (PEFR) with a local pulmonologist who ordered this data on Epic's EHR. For users who had installed and activated Epic's patient portal (MyChart) on their iPhone and enabled sharing of health data between apps via HealthKit, the pulmonologist could review PGHD and, if necessary, make recommendations. Four patients agreed to share data with their pulmonologist, though only two patients submitted more than one data point across the 4.5-month trial period. One of these patients submitted 101 PEFR readings across 65 days; another submitted 24 PEFR and inhaler usage readings across 66 days. PEFR for both patients fell within predefined physiologic parameters, except once where a low threshold notification was sent to the pulmonologist, who responded with a telephone discussion and new e-prescription to address symptoms. This research describes the technical considerations and implementation challenges of using commonly available frameworks for sharing PGHD, for the purpose of remote monitoring to support timely care interventions.

Why are adolescents using mobile apps?

Background Adolescents are using mobile health apps as a form of self-management to collect data on symptoms, medication adherence, and activity. Adding functionality to an electronic health record (EHR) to accommodate disease-specific patient-generated health data (PGHD) may support clinical care. However, little is known on how to incorporate PGHD in a way that informs care for patients. Pediatric asthma, a prevalent health issue in the United States with 6 million children diagnosed, serves as an exemplar condition to examine information needs related to PGHD. Objective In this study we aimed to identify and prioritize asthma care tasks and decisions based on pediatric asthma guidelines and identify types of PGHD that might support the activities associated with the decisions. The purpose of this work is to provide guidance to mobile health app developers and EHR integration. Methods We searched the literature for exemplar asthma mobile apps and examined the types of PGHD collected. We identified the information needs associated with each decision in accordance with consensus-based guidelines, assessed the suitability of PGHD to meet those needs, and validated our findings with expert asthma providers. Results We mapped guideline-derived information needs to potential PGHD types and found PGHD that may be useful in meeting information needs. Information needs included types of symptoms, symptom triggers, medication adherence, and inhaler technique. Examples of suitable types of PGHD were Asthma Control Test calculations, exposures, and inhaler use. Providers suggested uncontrolled asthma as a place to focus PGHD efforts, indicating that they preferred to review PGHD at the time of the visit. Conclusions We identified a manageable list of information requirements derived from clinical guidelines that can be used to guide the design and integration of PGHD into EHRs to support pediatric asthma management and advance mobile health app development. Mobile health app developers should examine PGHD information needs to inform EHR integration efforts.