Sunday, June 10, 2012

Results of Project HealthDesign

Patricia Flatley Brennan, PhD, R.N., National Program Director of the Robert Wood Johnson Foundation’s (RWJF) “Project HealthDesign”, presented results on the project’s research at the June 8th Federal HIT Policy Committee’s Meaningful Use Workgroup. She wanted to speak to the Workgroup as they envision how to incorporate the use of patient-generated data in the clinical setting into Stage 3 of the Meaningful Use program.

The Meaningful Use program has begun to take small steps to support patients and clinicians as they work together across domains, and now the criteria supporting the clinical integration of patient-generated data will further benefit this partnership as well as the business and technology of health and healthcare.

Brennan presented information on the experiences of all fourteen Project HealthDesign teams throughout two rounds of funding as well as the teams interactions with hundreds of patients.

In her presentation, she stressed three important points:

  • The need to expand the idea of patient-generated data to include patient-defined data
  • Sharing patient-defined data with clinicians improves the business of healthcare
  • Existing technologies are adequate but not optimal for the clinical integration of patient defined and patient-generated data
As Brennan explained, the project team worked with hundreds of patients and doctors to collect and track patient-generated data or what is referred to as Observations of Daily Living (ODL) data from patients such as sleep habits, pain levels, diet, and exercise patterns. The researchers discovered that the data provided meaningful clinical insights to better inform clinical treatment and decision-making.

Although the research explicitly focused on ODLs in the project, they also realized that other types of patient-generated data contributed to a full picture of a patient’s day-to-day health experience, The work showed that patient-generated data matters to the individuals who capture the data, and matter because they strengthen the patient-clinician partnership by allowing clinicians to see a more robust picture of the individual’s day-to-day health experience.

Integrating patient-generated data into the EHR can be important to support the clinician’s reasoning for clinical decision-making. This may occur through direct entry by a clinician, or by integrating portions of the data or data summaries into the EHR. Clinicians want sufficient documentation of patient-generated data to show the chain of reasoning so they can make the diagnoses and decide on treatments.

However, more research is needed to determine when patient-generated data must enter the EHR and when it does not need to be entered, plus additional research is needed to identify best practices for sorting, summarizing, and safely storing the data.

As healthcare business models begin to shift from fee-for-service to ACOs, Patient-Centered Medical Homes, technologies that make it possible to use patient-generated data could emerge as an important approach to enable patient self management and as important tools for patient case management outside of clinical visits.

Brennan suggests that someday, clinicians could prescribe mobile apps to patients and partner with patients to set targets for ODL data or other patient generated data. Today, current teams and their mobile apps serve only to capture and display data. In the future, mobile apps might include automated recommendations based on algorithms.

As the Meaningful Use program has progressed, the business model for EHR system vendors has evolved into a packaged IT system that can be sold. It is unlikely that we will see a business case for an EHR vendor to redesign its system to incorporate patient-generated data at a granular level.

Therefore, RWJF calls for Meaningful Use criteria to support the incorporation of patient-generated data into the HER and recommends functionality that would document the clinicians reasoning when it rests upon patient generated data. In this way, all of the raw patient-generated data would not need to enter the EHR but only data summaries relevant to a clinician’s decision-making process would be documented.

For more information on the project, go to