Is it really so easy to bring ODLs into the clinical workflow?

By Patricia Flatley Brennan.

We applaud the interest by large hospitals and medical practices to capture observations in daily living and integrate them into the clinical record. This kind of welcoming vision reaffirms the direction that we are taking as our five grantees partner with people with complex medical problems to identify ODLs that help them determine how they are doing, and then work to figure out where such observations enhance the clinical care process and contribute to better outcomes.

The technical advances now make it possible to turn our attention to the clinical, human factors and regulatory dimensions of the challenge of integrating patient self tracking into meaningful clinical care. These questions include:

1. How can we minimize patient burden but capture ODLs in enough detail to make them really useful?
2. What is the relationship between selected ODLs and the underlying physiological state of the patient? (That is, do ODLs give early insights into clinical state, or do they complement what traditional signs and symptoms tell us about how a patient is doing?)
3. Can we develop methods to interpret and feed back to the patient information about the ODLs that help them take meaningful health action?
4. What logistical problems must be solved to permit direct entry of ODLs into the clinical record (e.g. authentication, non-repudiation, secure transfer, efficient data storage and presentation)?
5. Which clinician is the right one to receive and interpret the ODLs?
6. How do we insure the proper regulatory protection for taking clinical action based on ODLs?

We expect to make significant progress towards answering these questions in Project HealthDesign as the design teams and their clinical partners will illuminate the real world experiences and challenges inherent in using ODLs. We're also looking forward to the regulatory analysis and guidance provided by Manatt and CDT to highlight where state and federal laws and regulations support (or inhibit) the use of ODLs in clinical practice.

We welcome any and all partners on the journey with Project HealthDesign! Join our forum discussion, tell us your experiences, share your solutions -- it will take lots of work in lots of fields to bring every day living into health, and health into every day living!

Comments

[Vince Kuraitis]

My educated guess is that doctors will be predisposed NOT to want to introduce ODLs into their workflow:
* Not sure what to do with the information; little science around ODLs
* Not paid to evaluate such information; a drain on productivity
* Potential liabilility for failure to take into account information which in hindsight has some relevance

So I hope you can address the "What's in it for me" question doctors inevitably will be asking.

[Leslie Kelly Hall]

Any clinical observation presented to a physician must be entered in a chart and reviewed. Are ODL the best selection for this? What is the high value observations that a physician would consider an important addition to the chart? Hard to know. However, one area that could provide value is patient decision making. If that observation included a summary of the education taken, the comprehension and the decision made, this would provide information into the record that would prove relevant to current and ongoing care. It is important to select carefully what type of patient generated information is integrated into the chart. I should be meaningful and relevant to the care provided. If not, and the information is considered spurious by the physician, all efforts for patient information integration could be thwarted.

[me.yahoo.com/a/lexbIvUzyvzglapA1Iw6YSyFgu6lZg--]

Leslie,

The point about clinical observations having to be entered into the chart is such a good one. We are just in the process of writing up a study on perceptions of PHR as collaborative systems. That paper is under review, so I won't overshare :) But here is just one quote from our interviews that I think really captures this issue. Many thanks to Leslie Liu, the graduate student focused on this study.

"There’s always a question about who’s going to be the custodian of the record, but really, if they had come from another hospital … I would attach my hospital’s number to [the paper record]…and actually submit this as part of our records, so, if it were ever an issue, you know, with a court or something, I acted on the best information I had at that time and here’s the information I have.”

Best,

Gillian