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

Abstract

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.

Keywords: Data integration; Information technology; Predictive markers.

Fig. 1

After patient/provider discussion and consent, both must act to enable PGHD collected in the patient’s mHealth app to appear in the provider’s EHR

Fig. 2

Patient views from the Asthma Health app and Epic’s MyChart app to enroll and enable sharing of PGHD. a After downloading the Asthma Health app, the patient enrolls and follows prompts to allow sharing of data with the iPhone’s Health App. Then patient is regularly prompted to enter inhaler use and PEFR. b After downloading and activating MyChart, the patient sees a message about a provider's peak flow tracking order and is prompted to connect data from the iPhone’s Health app to MyChart

Fig. 3

Provider's view in Epic’s Inbasket, when reviewing patient peak expiratory flow rates (this is simulated data from a virtual patient)

Fig. 4

The provider’s view in the Epic EHR. a The provider’s Epic view, when searching to order a patient’s peak expiratory flow rates. For data to flow into an Epic chart (specifically, a flowsheet), it must come from a patient’s MyChart app. b The provider’s Epic view when specifying notification settings for a patient’s peak expiratory flow rate data, including frequency and thresholds for notification