From smartphone to EHR: a case report on integrating patient-generated health data

• Published in: NPJ digital medicine Vol. 1; no. 1; p. 23
• Main Authors: Genes, Nicholas, Violante, Samantha, Cetrangol, Christine, Rogers, Linda, Schadt, Eric E., Chan, Yu-Feng Yvonne
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 20.06.2018; Nature Publishing Group
• Subjects: 631/114/2401; 639/705/258; 692/53/2423; Asthma; Biomedicine; Biotechnology; Case reports; Digital technology; Electronic health records; Health informatics; Inhalers; Medicine; Medicine & Public Health; Patients; Smartphones; Telemedicine; Web portals; Information technology; Data integration; Predictive markers
• ISSN: 2398-6352; 2398-6352
• DOI: 10.1038/s41746-018-0030-8

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. mHealth: Smartphone app syncs with health record to improve asthma care Patients with asthma who record inhaler usage and lung function scores with a smartphone app and transmit the data to an electronic health record (EHR) can get timelier care and prescription adjustments from their doctors. A team led by Yvonne Chan and Nicholas Genes from the Icahn School of Medicine at Mount Sinai in New York, NY, USA explored the feasibility of having patients self-report health data on an iPhone app called Asthma Health and then share the information with their pulmonologists via an EHR patient portal app. Four patients took part in the study, but only two really engaged in the platform. Those patients submitted multiple measures of peak expiratory flow rate per week. In one instance, the measure triggered a pulmonologist to call the patient and prescribe new allergy medications.