Patient-generated health data: Bridging the device-EHR divide

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders if their practice uses data from patient health wearables (e.g., Fitbit, Apple Watch): Only 5% answered “yes,” while 95% answered “no.” Respondents who answered “no” elaborated:

• Not enough time to evaluate. No sure how it would benefit patient care and outcomes. Most patients who wear these are trying to get healthy.
• I haven't seen a way to easily upload, analyze and clinically take advantage of such information. Wearable technology is advancing much faster than EHRs in this regard.
• EHR is not compatible with devices.

 
This poll was conducted on July 9, 2019, with 1,227 applicable responses.

The range of devices collecting data from patients outside the brick-and-mortar medical practice facility is growing, creating opportunities for providers to assess how best to collect and leverage this patient-generated health data (PGHD) for clinical purposes.

This burgeoning field in health IT has seen exceptional growth in the realm of consumer wearable fitness trackers, while providers have largely focused on specific devices to capitalize on the capabilities of remote patient monitoring (RPM) and the growing opportunities to be reimbursed for telehealth services.

A recent survey by VivaLNK finds that almost two-thirds (64%) of patients would use a wearable health device if it lowered how often they physically went to the hospital or doctor’s office.1 In short, there’s a lot of data out there but a relative shortage of best practices on how to bridge the gap between new apps and devices and your organization’s EHR.

In his recent MGMA podcast, Robert Tennant, MA, director of health IT policy, MGMA Government Affairs, pointed to interoperability as a major trend in health IT today. “The theory is that the seamless movement of patient data between care settings will result in improved care and decrease costs; however, I would argue that the jury is out,” Tennant said. “In some cases, too much data is as challenging as too little.”

“With physicians having only limited time with patients, they must be armed with the right data,” Tennant said. “And we can't waste their time by giving them information that is not relevant or actionable.”

Beyond the broader goal of advancing interoperability, the Office of the National Coordinator for Health Information Technology (ONC) has pointed to the next four years as a growth phase for PGHD adoption, in which more patients are willing to capture and share PGHD. In addition, adoption of interoperability standards makes it easier for clinicians and researchers to store, retain and analyze PGHD.2

Whether the healthcare industry reaches what the ONC deems as “maturity” for PGHD adoption — in which “PGHD truly transforms clinical care and research, improving clinical workflows, patient-centered outcomes and research, and surveillance of drugs and treatments”3 — remains to be seen, but there are clear indications as to what will influence whether that outcome is achieved.

For example: Northwell Health, a New York-based health system with more than 13,600 affiliated physicians, has piloted and built use cases for PGHD in various specialties and locations:

• Capturing PGHD for behavioral health through apps that engage patients for PHQ-9 and GAD-7 screenings.
• Building a vitals data platform for integration, storage and analysis of PGHD from sensors.
• Enabling a questionnaire on social determinants of health (SDoH) for patients to complete.4

While Northwell is pioneering in numerous areas of incorporating PGHD, it’s not without major challenges to overcome, according to Simita Mishra, PhD, director in the OCIO, Northwell Health, who leads the population health service line and the delivery system reform incentive payment (DSRIP) department.

“Previously the data was collected in a more structured and guarded environment, where the patient is already in their physician’s office,” Mishra said. “But now we are trying to collect the data at many different points.” Defining the context in which a blood pressure reading was taken, for example, will help make the circumstances that may affect the outcomes clearer.

Finding ways to collect PGHD and make it actionable is another challenge. “Data is useless unless we put it into action,” Mishra said. Even if you solve for effective storage of the data and handling the associated costs, she said, “how do we get the ROI on the expenses?”

Gaining buy-in from providers is crucial when integrating PGHD into the practice's clinical workflows to ensure the new PGHD-related tasks aren't overly burdensome and contribute to physician burnout. “How can we make sure it’s blended seamlessly into the clinicians’ workflow rather than creating any disruption?” Mishra says.

Michael Oppenheim, MD, vice president and chief medical information officer at Northwell, also emphasized the importance of providers in this initiative. “We think there’s a tremendous amount of value [in PGHD], but we’ve elected to move into it in very measured and very careful ways,” Oppenheim said. “But we really are trying to be conscious about the provider satisfaction side and the patient satisfaction side as we move into this.”

Some health experts are confident that wearable devices will be a major piece of the relationship between patient and provider in 20 years. Texas Medical Center is predicting that by 2039 that PGHD for step counts, heart rate, sleep patterns and much more will be readily available to providers before a patient is seen by his or her provider in person or via telehealth.5

According to Roberta Schwartz, PhD, chief innovation officer, Houston Methodist Hospital, “we are rapidly moving to a world where your health status can be monitored from home, uploaded and tracked by health professionals using sophisticated software to proactively identify patients at risk of certain health issues.”6

Additional resources:

• “Should you be using data from your patients’ consumer health wearables?” (MGMA Stat)
• “Integrating data from ‘wearables’ into EHRs” (MGMA Stat)
• “Wearable medical devices give abundant data — and risks” (Michigan State Medical Society)

Notes:

1. Landi H. “Patients will use health wearables to reduce trips to the doctor: survey.” FierceHealthcare. June 25, 2019. Available from: bit.ly/2Ye9FWx.
2. “Conceptualizing a data infrastructure for the capture, use, and sharing of patient-generated health data in care delivery and research through 2024.” ONC. January 2018. Available from: bit.ly/2XyyQSK.
3. Ibid.
4. “Utilizing patient-generated health data: Opportunities in preventive wellness, population health, and remote care.” The Learning Center. June 18, 2019. Available from: bit.ly/2G2QSqc.
5. Pierce S. “What to expect from a doctor’s visit in 20 years.” TMC News. June 3, 2019. Available from: bit.ly/2ETQIRr.
6. Ibid 

MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: http://www.mgma.com/stat