Patient-Initiated Data: Our Experience with Enabling Patients to Initiate Incorporation of Heart Rate Data into the Electronic Health Record

Abstract Background Provider organizations increasingly allow incorporation of patient-generated data into electronic health records (EHRs). In 2015, we began allowing patients to upload data to our EHR without physician orders, which we henceforth call patient-initiated data (PAIDA). Syncing weara...

Full description

Saved in:

Bibliographic Details
Published in:	Applied clinical informatics Vol. 11; no. 4; pp. 671 - 679
Main Authors:	Pevnick, Joshua M., Elad, Yaron, Masson, Lisa M., Riggs, Richard V., Duncan, Ray G.
Format:	Journal Article
Language:	English
Published:	Stuttgart · New York Georg Thieme Verlag KG 01-08-2020
Subjects:	Cardiologists Electronic Health Records Heart Rate Humans Medical Informatics - methods Quality Control Research Article Wearable Electronic Devices mHealth atrial fibrillation patient–provider portal patient-generated data
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Abstract Background Provider organizations increasingly allow incorporation of patient-generated data into electronic health records (EHRs). In 2015, we began allowing patients to upload data to our EHR without physician orders, which we henceforth call patient-initiated data (PAIDA). Syncing wearable heart rate monitors to our EHR allows for uploading of thousands of heart rates per patient per week, including many abnormally low and high rates. Physician informaticists expressed concern that physicians and their patients might be unaware of abnormal heart rates, including those caused by treatable pathology. Objective This study aimed to develop a protocol to address millions of unreviewed heart rates. Methods As a quality improvement initiative, we assembled a physician informaticist team to meet monthly for review of abnormally low and high heart rates. By incorporating other data already present in the EHR, lessons learned from reviewing records over time, and from contacting physicians, we iteratively refined our protocol. Results We developed (1) a heart rate visualization dashboard to identify concerning heart rates; (2) experience regarding which combinations of heart rates and EHR data were most clinically worrisome, as opposed to representing artifact; (3) a protocol whereby only concerning heart rates would trigger a cardiologist review revealing protected health information; and (4) a generalizable framework for addressing other PAIDA. Conclusion We expect most PAIDA to eventually require systematic integration and oversight. Our governance framework can help guide future efforts, especially for cases with large amounts of data and where abnormal values may represent concerning but treatable pathology.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1869-0327 1869-0327
DOI:	10.1055/s-0040-1716538