To make remote monitoring devices interoperable, we must examine a variety of use cases and the current evidence of their effectiveness. The presentation is from the January 2020 IHE Connectathon in Cleveland, Oho.

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Personal Connected Health:
Patient Generated Data Use Cases
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John Sharp
Director, Thought Advisory, HIMSS

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An examination of the current
state and projection of the
future state of PGHD reveals
the opportunities, challenges,
and calls to action for the main
health care stakeholders, as
well as supporting stakeholders.
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ONC PGHD Report, 2017

3. PGHD Adoption Curve – ONC 2017
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5. The Rise of the Data-Driven Physician –
Stanford Medicine 2020
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6. Remote Patient Monitoring
Why Now?
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• Better technology including
miniaturization of sensors
• Pervasive wireless networks including
home networks
• Smart phones enabled with Bluetooth
• Growth of wearables -consumerization
• Incentives – CPT codes for
reimbursement, value-based care,
financial penalties
• Regulatory changes – FDA approvals

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Who Sees the Data?
• Providers need data in a format that they can interpret and act on
• Within the EMR context
• Outside the EMR – within a ACO or Chronic Disease Management
system
• Patients – See the data in ways that they can interpret and take action
• Usually through and app or small dashboard on the device
• Device/app companies
• Only to provide technical support

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Use Cases - Remote Patient Monitoring
• Atrial Fibrillation
• Cardiac Rehab
• Heart Failure
• Hypertension
• Diabetes
• Mental Health

9. Atrial Fibrillation
Apple Heart Study
The Apple Watch and corresponding Heart Study app uses
photoplethysmography to intermittently measure blood flow
activity
and detect subtle changes that might indicate an irregular
heartbeat.
• 419,297 people self-enrolled in the study
• A pulse notification was received by 2,161 participants (0.52 %)
• While the watch and corresponding app "offers promise," its
accuracy is still far short of more traditional and currently
used monitoring techniques.
• No interoperability – those who got notifications were instructed
to contact the study doctor.
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10. Apple Watch Study - Implications
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• Recruitment of people using
wearables shows potential for large
sample sizes
• Concerns about false positives
• May be more effective focusing on
those with heart disease
• Lack of interoperability – particularly
moving data to the EMR
for effective disease management
• Future application to diagnostics and
symptom identification
through wearables
New Apple Studies
• Women’s Health Studies
• Heart and Movement
Study
• Hearing Study

11. Home-Based Cardiac Rehabilitation Program
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• Compliance with cardiac
rehab is poor
• Requires weeks of outpatient
rehab appointments
• Often means a caregiver
transporting the patient daily
• Drop-out is high

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Kaiser – Samsung partnership
• Samsung smartwatch that pairs via Bluetooth
with an Apple or Android smartphone
• The watch sends reminders to the patient to
exercise, collects
patient activity data and continuously displays
the patient heart rate during exercise
• uploaded via the smartphone into the patient's
chart (via FHIR?)
Home-Based Cardiac Rehabilitation Program

13. Incentives – CMS will not pay for readmission
within 30 days
The hope is that more intensive monitoring in
the community can identify decompensation
early, support adherence to lifestyle and medication,
and prompt intervention
Now included in guidelines by the European Society of
Cardiology and the American College of Cardiology, with caution about
limited evidence
The potential is great. “RM will find an important place for those living with HF
and the professionals advising them.”
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Heart Failure

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Cardiac Failure Review 2019;5(2):86–92.

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Hypertension
Front. Cardiovasc. Med., 13 June 2019

16. • People living with the Type 1 rarely have to seek professional
assistance
• Their blood glucose concentrations can easily be incorporated
into data platforms that can be accessed by patients, their carers
and their healthcare professionals at any point in time and from
anywhere there is internet access to the cloud-based server.
• For those requiring insulin, there are now patches that monitor
blood glucose every few minutes, and wirelessly communicate
with an insulin pump to help ensure stable blood glucose control.
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Diabetes

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Diabetes – Closed loop

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Diabetes – closed loop

19. Standards should include consideration of:
• data safety and privacy (data storage, use and sharing
policies must be made transparent to users of the app)
• effectiveness
• user experience/adherence
• data integration (via APIs using open standards)
Towards a consensus around standards for smartphone apps
and digital mental health, World Psychiatry. 2019 Feb; 18(1): 97–98.
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Mental Health

20. 1. What seems obvious to an engineer (or informatics manager) may not be obvious to a
patient.
2. What seems quick and easy may strike the patient as burdensome.
3. Questionnaires developed for research may not be appropriate for clinical practice.
4. Many words used by doctors and researchers can be replaced by something simpler
5. Don’t ask questions for clinical care unless you are prepared to act
6. A subgroup of users can cause a great deal of additional work
7. Watch patients use your tool and ask about their experiences.
8. Patient trust is hard to gain and easy to lose
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Interfaces for collecting data from patients:
10 golden rules – JAMIA Jan. 2020

21. • There are now several use cases for collection of PGHD via remote
monitoring and apps
• Initial evidence of clinical improvement is mixed
• Implementation of remote monitoring needs more standardization to scale
• Reimbursement is now available through CMS which will incentivize RPM
• Data transfer can be via Bluetooth
to a mobile platform or direct to cloud
• Data integration is enabled via APIs
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Summary

22. Your health is not a number. Be
careful when evaluating your health.
Your habits are more than numbers
to be hacked.
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“
Chris Dancy, The World’s Most Connected Person
Don’t Unplug

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Questions

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Contact me
Linkedin.com/in/johnsharp
@JohnSharp
john.sharp@himss.org
PCHAlliance.org