Patient and Doctor

Integrating Patient Generated Data with an EHR. Can the Information be Trusted?

The topic of this week’s featured article may very paternalistic; however, it is not intended to offend. If medical data is collected by knowledgeable individuals (e.g. with Diabetes Mellitus) and shared via a patient portal or email with a care provider, of course it should be trusted, right? In certain cases yes, but not always. It is highly dependent on how the data within the EHR is going to be used and who else may be using the record.

Here are some important points to consider:

  • What kind of data will be collected by patients and how will that data be shared with a provider or entered into the EHR?
  • If devices are used to collect the data, e.g. glucometers or weight scales, how frequently are the devices calibrated and checked for accuracy?
  • Is the information being used to monitor trends as supportive information, or is it critical data that could impact life-and-death decisions?
  • Is there an element of manual error that can be introduced when data is collected, e.g. through transcription from a device to a spreadsheet (which is then emailed to the provider), or is the data reported directly from the device to the EHR?
  • When data is shared by a patient with their care provider, how frequently is data reviewed before being accepted into the EHR?
  • Can the data be rejected if it is felt to be inaccurate (e.g. calibration issues) and what is the follow-up process, e.g. office visit, telephone call, home visit, etc.?
  • How is the data segmented in the EHR (i.e. kept separate from other results and information)?
  • What is the single source of truth for critical healthcare information? An example of this is a new medication allergy. Consider a patient who has no history of allergies to any medications. That individual is prescribed a number of medications due to an acute respiratory infection, treated at the local hospital. One of the medications prescribed is an antibiotic called Moxifloxacin. The individual develops a skin rash and decides to discontinue all medications. He reports to his primary care physician (through the patient portal) that he has developed an allergy to Moxifloxacin. Should that information be integrated into the EHR? Can it be trusted as a source of truth?

Electronic Health Records (although quite limited in terms of the sharing of information in a doctor’s office) are really information exchange systems. When operating effectively, they are designed to share information between multiple sources, effortlessly and securely. As a result, it is highly likely that an individual’s personal health information will exist in multiple locations and in multiple health information systems. This may also cause conflicts. Generally, the primary care physician’s EHR is considered a trusted, if not the most trusted, source of information. As a result, information stored in the physician’s EHR needs to be as accurate as possible because of the potential for that information to be propagated electronically to other systems through shared records, referrals, or consultation reports where information is automatically abstracted from the EHR.

While this is a hypothetical example, it is true that with any computer system, the quality of information that you get out is directly proportional to the quality of information that goes in.

The question is not whether patient generated data in an EHR can be trusted, but rather what policies and procedures need to be put into place to ensure that data is collected, transmitted, shared, and accessed in accordance with best practices. Integrating clinical data from any source requires adjustments to workflow and care delivery processes. These need to be carefully thought through before proceeding.

Do you use an EHR and integrate patient generated data? What are the pros and cons? Share your experiences and thoughts.

Comments:

One response to "Integrating Patient Generated Data with an EHR. Can the Information be Trusted?"
  • June 30, 2011
    William Cast, M.D.
    said:

    Trusted? I doubt that policies and procedures can do more than bring fidelity and authenticate. It is not a matter of trusting patient generated data, it is as William Osler said: “Listen to the patient. He is telling you the diagnosis.” The PHR is the record of what the patient wants you to know. It is her written history and most likely to equate to her verbal history. Worrying whether it is accurate is not the point. What is not in the history—what is left out—may be as important as what is included. No doubt best practices give a nod to the sacred nature of the patient’s own story. We should not expect it to be more or less than it is. We should expect that it be recorded accurately and distributed easily to all care givers properly involved.
    The EHR is the tool of the hospital and physician. The PHR is an equivalent software platform that allows the patient a place at the digital table.

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