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. 2020 Feb 1;59(2):367-378.
doi: 10.1093/rheumatology/kez207.

Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record

Lynn Austin  1   2 , Charlotte A Sharp  1   3   4   5 , Sabine N van der Veer  3   6 , Matthew Machin  6 , John Humphreys  1 , Peter Mellor  1 , Jill McCarthy  5 , John Ainsworth  6 , Caroline Sanders  1   2   7 , William G Dixon  1   3   4   8
Affiliations

Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record

Lynn Austin et al. Rheumatology (Oxford). .

Abstract

Objectives: To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA.

Methods: The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically.

Results: Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients' RA more visible by providing the 'bigger picture', identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.

Conclusion: Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

Keywords: RA; doctor–patient communication; patient-generated health data; remote monitoring; smartphones.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Screen-shots of the Remote Monitoring of RA app functionality including a slider, stepper and radio buttons
<sc>Fig</sc>. 2
Fig. 2
System architecture for integrating data from the smartphone app to the electronic health record
<sc>Fig.</sc> 3
Fig. 3
Flow of data from smartphone at home to display in electronic health record within consultation
<sc>Fig</sc>. 4
Fig. 4
Extracts and graphs from Round 2 clinical consultations from participants P2 (A) and P12 (B)
See this image and copyright information in PMC

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