HIPAA Security Rule Compliance When Communicating with Patients Using Mobile ...
Connected health no movie
1. Listening in the Moment:
Project HealthDesign
Opens the Window on the
Every-day Lives of Patients
Patricia Flatley Brennan, RN, PhD
University of Wisconsin-Madison
Madison, WI USA
Support provided by UW Madison, RWJF
3. The CARE between the CARE –
listening to the every-day experience of people
January June December
4. Professionals are
experts in
clinical care
People are experts in
every-day living
5. Observation of Daily Living
ODLs
• Thoughts, feelings, behaviors & actions, and
exposures
• Cues towards action rather than indicators of
pathology
• Idiosyncratic, personally meaningful
8. People LIVE everyday,
not just at the hospital or clinic
• http://www.projecthealthdesign.org/projects/
round-1-projects/personal-health-application-
for-diabetes-self-management
9. What’s important to Jim
1. Negotiating a loan
2. Opening his own shop
3. Stress
4. Exercise
5. Medication
6. Hypoglycemia
Which of these DOESN’T have a
SNOMED code?
10. The Language of Health in every-day
Feedback
Plan Play Basketball
exercise
Stress
running
See how I am
H1c doing advice
Keep in medication
decide track Glucose
Stay on How to
top eat
Blood
Sugar
11. The Language of Health in every-day
Feedback
Plan Play Basketball
exercise
Stress
running
See how I am
H1c doing advice
Keep in medication
decide track Glucose
Stay on How to
top eat
Blood
Sugar
12. The Language of Health in every-day
Patient Focused Patient Defined
Feedback
Plan Play Basketball
exercise
Stress
running
See how I am
H1c doing advice
Keep in medication
decide track Glucose
Stay on How to
top eat
Blood
Sugar
13. The Language of Health in every-day
Patient Focused Patient Defined
Clinical Terms Observation of
Feedback Daily Living
Plan Play Basketball
exercise
Stress
running
See how I am
H1c doing advice
Keep in medication
decide track Glucose
Stay on How to
top eat
Blood
Sugar
14. The Language of Health in every-day
Patient Focused Patient Defined
Clinical Terms Observation of
exercise
Daily Living
Plan Play Basketball
H1c Stress running
decide
Blood Blood
Glucose advice medication Sugar
Keep in
track
Feedback Stay on Eat right
top See how I am
doing
15. HIT can bring the language of
every day health into clinical care!
• Professional
terms: Blood
glucose, activity
tolerance
• Personal terms:
open my own
shop, go for a
run
16. Project HealthDesign Round 2
• Engaged five teams to demonstrate a new vision for improved patient care
through integration of patient-generated health data into every day lives and
clinical practice
• Explored the technical, legal and policy implications of incorporating patient
generated data in health care
17. • dwellSense
Elders at risk of cognitive decline
• Estrellita
High risk infants and their caregivers
• Chronology.MD
Young adults with Crohn’s Disease
• BreatheEasy
Adults with Asthma
• iN Touch
Low-income teens and young adults
managing obesity
19. BreathEasy: An application for adults with asthma & depression or
anxiety
“What we're developing will
enable patients and clinicians to
communicate more quickly and
easily . . .”
20.
21. Example 1: Significant improvement after a controller
medication was started without an office visit
(early 30’s, smoker, no other significant health issues)
22. Example 2: Different diagnosis suspected, escalated to specialist
care, immunotherapy planned
(early 50’s with comorbid hypertension, depression, chronic pain, and lupus erythematous)
24. BreathEasy Architecture
Home RTI Clinic
Web/App Nurses/
BreathEasy BreathEasy
Server Physicians
Patient
Patient Mobile App Dashboard
Patient ODLs:
• Peak flow rate
• Controller Med. Adherence
• Rescue Med. Usage
Messaging
• Asthma Triggers Server
• Asthma Symptoms
• Activity Level/Types
• Depression Level
• Anxiety Level
• Sleep Patterns
• Smoking Habits
Challenges: Data Integration
•Third party storage
•Integration with EHR
25. What did people do with ODLs?
• Recognize when symptoms became problematic
• Recognize effects of new medications on symptoms
• Increase awareness of triggers
• Reminders for daily tasks performance and monitoring
• Adhere to doctors’ instructions since s/he “would
know”
• Know when medication refills were due
• Report about health during doctors’ appointments
• Gain insights to health behaviors, set goals, and
improve health choices
26. The Patient Experience
• ‘I don’t feel so alone’ (patient w/ Crohn’s)
• ‘My quality of life has gone way up’. . . ‘my weight is up’ . . .
‘I’m not vomiting every day’
• ‘It’s easier to summarize and share between-visit health
events and health status’
• ‘good intentions to use the app, but not enough energy at
the end of the day’ (parents of twin at-risk infants and two pre- school
kids)
• ‘I charge the study phone before my personal cell’
• ‘missed more medication doses than I expected’ (elder at risk)
27. What did clinicians do with ODLs?
• Change a target peak flow rates
• Make a new or correct an existing diagnosis
• Monitor psychological issues
• Understand of the impact of sleep and/or exercise on
pain
• Track patient weight
• Make informed referrals based on increased
knowledge of patients' symptoms
• Better understand patient health status at home
• Adjust medication regime
What we have done through Project HealthDesign is piloted how data about observations of daily living – or ODLs – can be collected, interpreted, and acted upon by patients and clinicians. ODLs can include information about things that are personally meaningful to people and that indicate how they feel – such as mood, pain, appetite, sleeping patterns, energy levels, exercise, etc.
The five Round 2 Project HealthDesign teams worked with real patients to use new technologies such as smartphones and iPads to collect observations of daily living and share selected ODL data with clinicians in order to improve care.My project involved [provide one-sentence description of your project]. I’m going to talk more about it in a minute.
Out of curiosity, I entered the ODLs that the five Round 2 teams will collect into Wordle.What I see is a mix of qualitative (subjective) and quantitative (objective) data.It also points out how important the grantees attention to analysis, interpretation of the raw data is; as well as the display of the analyzed or trended data.
Quote: “easily…and more accurately track environmental and behavioral effects on our health.“Barbara L. Massoudi, Principal Investigator, RTI InternationalAsthma is a common, chronic illness, affecting over 23 million adults in this country. In addition to respiratory symptoms associated with the disease, individuals with asthma are also more likely to experience depression and anxiety. RTI International and Virginia Commonwealth University will design a personal health record application, BreathEasy, building on the latest clinical guidelines for treatment and self-monitoring for patients with asthma and depression. Patients will interact with the application through smartphone mobile devices and biomonitors to capture and report observations of daily living (ODLs) such as use of controller and rescue medications, symptom levels, quality of life and smoking. Clinicians will utilize a Web-based dashboard providing simple analysis and visualization tools that allow them to quickly view their patients’ data, evaluate their health status and communicate any changes in treatment or monitoring. By providing a clearer picture of their health in everyday life, the ODLs will be used by both the patients and their clinicians to make lifestyle and treatment adjustments that will better manage their asthma and depression.