Mark Groshek is a practicing pediatrician with Kaiser Permanente in Colorado, and also the medical director of the digital services group — the organization within Kaiser Permanente that runs its patient portal, KP.org. He is speaking at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Chicago about the benefits of patient-generated health data, for both physicians and their patients.
Physicians Practice: Can you tell us about the presentation that you are giving at HIMSS?
Mark Groshek: I am giving a presentation with Dr. Carolyn Kerrigan from Dartmouth-Hitchcock Medical Center. The topic is patient-generated health data. The desire is to give some practical approaches to integrate patient-generated health data into an organization, in a way that minimizes disruptions.
PP: When you talk about patient generated data, what do you mean?
Information uploaded from remote monitoring devices, such as a cardiac monitor? Or wearable devices like a Fitbit, that measure physical activity?
MG: It could include all of that. It's what we would call "non-transactional health data." It's not something that happens in the office. But it can include questionnaires to get information for a health history, symptoms, a treatment history, lifestyle questions like, "Do you smoke, or exercise?" and so forth. It can include biometric data [collected through] medical devices like a blood glucose meter.
PP: So it is helpful to the physician because it comes directly from the patient, and it can be uploaded (sometimes automatically) into the record. Are there other advantages to the physician?
MG: Well, we don't have to transcribe it. So it's just more efficient for everybody, and it is more accurate. If it is in an electronic format, it also means you can analyze data in ways that are just hard to do if it is on paper. You can get information outside of the context of an office visit. It can be during a visit, but it can also be something that can be used to substitute or augment for a visit.
PP: Your organization has been conducting a pilot study which looks at the benefits of using patient-generated data to help manage diabetic patients. Can you give us the highlights?
MG: The patients who have been involved in this are patients whose diabetes has been out of control, so the goal is to get them under better control. [Diabetes care managers] were doing phone calls every one to two weeks, and looking at the blood sugar readings and giving advice about what to do next.
With our glucometer pilot, our care managers were able to receive the blood sugar readings directly, instead of spending the first half of the phone call writing down what the patient told them. [Data is uploaded directly into a portal, from the patient device.]
What we expected to find was that the nurses were able to take care of more patients, or spend less time on the call but still accomplish the same goals. And that did happen. But what also happened was having this visual representation [graphs depicting glucose curves] of the information helped patients to get into control more effectively and faster than has been typical.
PP: Are there liability issues that providers should be aware of when using patient-generated data?
MG: There are a number of things to consider. It is necessary to be able to validate that the data is accurate. You need to know that the glucometer is accurate and all of those things; which wasn't a problem for us, because we supplied the glucometers.
I think there is a question if the data is being uploaded and there is something that is not normal, who is responsible for that? We address that by clearly laying out in the terms and conditions of participating in this pilot, laid out that the patients (they can tell if there is an abnormal glucose result as well, the glucometer tells them that) need to take the responsibility to contact their care manager if there is an abnormal result and they are not sure what the next step is.
The other thing we thought was important, if you are making or changing a medical decision, that information should be part of the EHR. And in this pilot we didn't have an interface from the system that accepted the information into our EHR. The care managers had to copy and paste the curves and information that they were using into their clinic notes in the electronic record.
Groshek is a featured speaker at HIMSS. His session, "Proudly Accepting Patient-Generated Health Data" is scheduled for Wednesday, April 15, from 10 a.m. to 11 a.m. CT.