Integrating patient-generated data into EMR: Which road to travel?

By Joseph C. Kvedar
08:31 AM

Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
”   Robert Frost

I received two emails from organizational leadership in the past week that represent milestones to me.  One was about our efforts to better manage populations in the context of risk-bearing (pay-for-value) contracts with our payers: “[Partners] is undergoing a planning process to determine what we can do over the next 3 years (2015 to 2017) to better prepare for increased risk in payer contracts….there is a segment of our Hypertension and Diabetes population (and CHF) that would benefit from telemonitoring.”  The language here is not dramatic, but the recognition that patient-generated data can be a critical tool for population health management and improved efficiency of care delivery is something we have strived to demonstrate over the last 10 years or more.  It feels good to hear it come from others.

The second email came from a senior IT architect: “[The data integration team] are working with the Center for Connected Health to get remote monitoring data into [a scalable, secure database].  From there, the plan is to have the data viewable from, but not necessarily resident in, Epic.”  Again, the words are not dramatic in nature, but the recognition, at the highest levels of our IT organization, that it is critical to our future to incorporate patient-integrated data into the care delivery process is a milestone.

I blogged a few months back about how we created the platform referenced in the paragraph above, allowing the easy integration of patient-generated data into our core clinical systems.  In fact, we are deliberately using this platform to integrate our Patient-Reported Outcome Measures into the system.  This will enable us to bring in both patient self-reported data as well as objective, biometric data and eventually perform analytics on these two data sets.

Partners HealthCare believes that patient-generated data is critical to our future and we’re managing this integration proactively.  That does not mean our work is finished.  For example, there is currently a significant overhead in managing remote sensors (BP cuffs, scales, etc.) and home hubs (2Net hub, Alere’s Connect device), and getting them back from patients after the program is complete (all of our Connect programs are time-limited).  The overhead of purchasing that gear and managing inventory adds cost to the programs and strains ROI calculations.

Why not use what the mobile industry calls BYOD (bring your own device) and software apps on smartphones/tablets?  That way, patients who own their own health sensors (so many are available in the consumer space these days) and mobile devices can participate at a much reduced cost to the delivery system.

A recent article in Health Data Management (Providers, Payers Get Appy) sheds some light on what other marquee health care organizations (Kaiser, Geisinger, Children’s Hospital and Aetna were featured) are thinking about the issue of integrating patient-generated data.  There are some parallels and some differences to the way we’re approaching it at Partners.

I should caveat the next section of this post by saying that I only read the piece in HDM and did not talk to any of these folks personally.  I do know all of these organizations, and have, in the past, spoken with their leadership about their strategies and continue to learn from each other.  So I think my analysis is solid.  However, I could be wrong.

The biggest difference I see is their belief that patients are already hopping on the bandwagon of buying their own sensors and generating their own data in some sort of massive wave –and that they are all using smartphones and tablets.