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

Lynn Austin; Charlotte A Sharp; Sabine N van der Veer; Matthew Machin; John Humphreys; Peter Mellor; Jill McCarthy; John Ainsworth; Caroline Sanders; William G Dixon

doi:10.1093/rheumatology/kez207

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

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

Authors

Lynn Austin^{1

2}, Charlotte A Sharp^{1

3

4

5}, Sabine N van der Veer^{3

6}, Matthew Machin⁶, John Humphreys¹, Peter Mellor¹, Jill McCarthy⁵, John Ainsworth⁶, Caroline Sanders^{1

2

7}, William G Dixon^{1

3

4

8}

Affiliations

¹ National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Salford Royal NHS Foundation Trust, Salford.
² National Institute for Health Research School for Primary Care Research, The University of Manchester.
³ Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester.
⁴ NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre.
⁵ Alliance Manchester Business School, The University of Manchester.
⁶ Centre for Health Informatics, Division of Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester.
⁷ National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester.
⁸ Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Data Collection*
Electronic Health Records*
Feasibility Studies
Focus Groups
Humans
Mobile Applications*
Rheumatology*
Smartphone*

Abstract

Publication types

MeSH terms

Grants and funding