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CSE5810: Intro to Biomedical InformaticsCSE5810: Intro to Biomedical Informatics

Mobile Computing to Impact Patient Health and Data Exchange

and Statistical Analysis

Presenter: David N. Etim

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OutlineOutline IntroductionIntroduction Research ObjectivesResearch Objectives Mobile Work in Health CareMobile Work in Health Care Electronic Medical RecordsElectronic Medical Records Studies on Patient CareStudies on Patient Care

Research Design, Methods, Analysis Comparison of Studies

Physician-Patient Relationship EffectsPhysician-Patient Relationship Effects SummarySummary

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IntroductionIntroduction Health information sharing between patients and Health information sharing between patients and

health care providers:health care providers: Diagnosis improvement Increase patient’s understanding Promotes independent care

Researchers want to educate and empower patients Researchers want to educate and empower patients to learn more about health data sharingto learn more about health data sharing Patient-Physician interaction is encouraged,

leads to patient education of self-care

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Research ObjectivesResearch Objectives Compare techniques and experiments in how mobile Compare techniques and experiments in how mobile

computing impacts clinical data exchangecomputing impacts clinical data exchange How does it affect data analysis? How is it helpful to patients to view medical

records? View strengths and weaknesses of patient interaction View strengths and weaknesses of patient interaction

with online medical recordswith online medical records Compare and contrast between different views and Compare and contrast between different views and

information about how medical data is sharedinformation about how medical data is shared

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Mobile Work in Health CareMobile Work in Health Care What exactly is mobile work?What exactly is mobile work?

Usage of mobile technologies in varying degrees to accomplish tasks

Mobile work within hospitals is complex and Mobile work within hospitals is complex and sophisticatedsophisticated

Mobility of resources and individuals are at the center Mobility of resources and individuals are at the center of patient diagnosis, treatment and careof patient diagnosis, treatment and care

Health care scenarios contain flexibility and work well Health care scenarios contain flexibility and work well with information exchangewith information exchange

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Electronic Medical RecordsElectronic Medical Records Digital version of a paper chart containing all of Digital version of a paper chart containing all of

patient’s medical history from one practicepatient’s medical history from one practice Mostly used for diagnosis and treatment

Benefits:Benefits: Tracks data over time Identifies patients due for preventive visits and

screenings Monitors how patients measure up to parameters Vaccinations, blood pressure readings, etc. Improves overall quality of care

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Electronic Medical RecordsElectronic Medical Records What’s the difference between EMRs and EHRs?What’s the difference between EMRs and EHRs?

Electronic Medical Records contain standard medical data collected in a provider’s office

Electronic Health Records (EHRs) consists of standard clinical data along with more comprehensive patient history

EHRs are designed to hold and share information from EHRs are designed to hold and share information from all providers involvedall providers involved Data can be created, managed, and consulted by

providers and staff EMRs aren’t able to allow a patient’s health record to EMRs aren’t able to allow a patient’s health record to

move with them to other health care providers, move with them to other health care providers, hospitals, and vendorshospitals, and vendors

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Studies on Patient CareStudies on Patient Care Studies done in the area of health data exchange Studies done in the area of health data exchange

involving mobile computinginvolving mobile computing Comparison of two studies:Comparison of two studies:

1. Testing Web-based care management of glycemic control using a shared electronic medical record with patients who have type 2 diabetes

2. Assessment of patients using online medical records and impact on patient care and clinical operations

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WEB-BASED CARE WEB-BASED CARE MANAGEMENTMANAGEMENT

Study #1Study #1

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IntroductionIntroduction Study aimed to improve glycemic control using a care Study aimed to improve glycemic control using a care

managermanager Wagner’s Chronic Care Model

Four Domains:Four Domains: Self-management support Delivery system design Clinical information systems Clinical decision support

Trial conducted at the University of Washington Trial conducted at the University of Washington General Internal Medicine ClinicGeneral Internal Medicine Clinic

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Research Design and MethodsResearch Design and Methods Participants enrolled in a 12-month open, randomized, Participants enrolled in a 12-month open, randomized,

controlled trial with parallel group designcontrolled trial with parallel group design 7,000 patients used in trial

Patients with type 2 diabetes randomly assigned to Patients with type 2 diabetes randomly assigned to group receiving online care managementgroup receiving online care management

EMR data used to identify potential participants EMR data used to identify potential participants between ages of 18 and 75between ages of 18 and 75

Patients excluded from study because of trial criteria Patients excluded from study because of trial criteria participated in pilot study, have major

psychological illness, non-English speaking

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Research Design and MethodsResearch Design and Methods Participants introduced to Web-based programParticipants introduced to Web-based program Encouraged to review online records, send weekly Encouraged to review online records, send weekly

blood glucose readingsblood glucose readings Send e-mail updates if necessary

All providers used same electronic medical recordAll providers used same electronic medical record Patient specific reminders for measurement of Patient specific reminders for measurement of

Gamma-Hydroxybutyric acid (GHb) (GHb)

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ResultsResults Analysis of outcome included all randomly Analysis of outcome included all randomly

allocated participants with available outcome dataallocated participants with available outcome data Primary analysis used linear regression with Primary analysis used linear regression with

change in GHb as dependent variablechange in GHb as dependent variable Trial was designed to have 80% power to locate a Trial was designed to have 80% power to locate a

difference of 0.5% in GHb concentrationdifference of 0.5% in GHb concentration Systolic and diastolic blood pressure, cholesterol Systolic and diastolic blood pressure, cholesterol

levels, and usage of health care services didn’t levels, and usage of health care services didn’t create differences between groupscreate differences between groups

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Statistical AnalysisStatistical Analysis

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Statistical AnalysisStatistical Analysis

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ELECTRONIC ELECTRONIC COMMUNICATION TO COMMUNICATION TO PATIENTSPATIENTS

Study #2Study #2

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IntroductionIntroduction Clinical trial conducted in specialty clinic at Clinical trial conducted in specialty clinic at

University of Colorado HospitalUniversity of Colorado Hospital Patients with Class II or Class III symptoms of Patients with Class II or Class III symptoms of

heart failureheart failure Project ObjectivesProject Objectives

Assess how a patient-accessible online medical record affects patient care and clinic operations

Providing patients with secure access to their medical records using the Internet

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InterventionIntervention Participants in intervention group were given a Participants in intervention group were given a

username and password for System Providing username and password for System Providing Access to Records Online (SPARRO)Access to Records Online (SPARRO)

SPARRO provides a Web interfaceSPARRO provides a Web interface Medical record Educational guide Messaging system

Patients in control group continues to receive Patients in control group continues to receive standard care in practicestandard care in practice

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Data CollectionData Collection Throughout study period, dates were tracked for Throughout study period, dates were tracked for

when patients used SPARROwhen patients used SPARRO If a single participant used a component of If a single participant used a component of

SPARRO multiple times on a given day, counted SPARRO multiple times on a given day, counted as “patient hit day” for that componentas “patient hit day” for that component

Messages tracked and sent through SPARRO Messages tracked and sent through SPARRO system to providerssystem to providers

Mobile phone messages tracked through review of Mobile phone messages tracked through review of medical records and logsmedical records and logs

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ResultsResults The intervention group was higher in adherence The intervention group was higher in adherence

compared to being at a lower rate in self-efficacycompared to being at a lower rate in self-efficacy more emergency department visits

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Comparison of StudiesComparison of Studies Both studies and others previously have Both studies and others previously have

demonstrated improvements in adherence and demonstrated improvements in adherence and satisfaction with physician-patient interactionsatisfaction with physician-patient interaction

Patient-accessible medical records increased Patient-accessible medical records increased workloadworkload

Great efficiency in both techniques in systemsGreat efficiency in both techniques in systems Patients learned that data is not up to date unless Patients learned that data is not up to date unless

having clinical encounters or involved in lab having clinical encounters or involved in lab studiesstudies

Electronic messaging does not substitute for phone Electronic messaging does not substitute for phone communicationcommunication

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Effects of Physician-Patient InteractionEffects of Physician-Patient Interaction Physician-patient relationship may be an important Physician-patient relationship may be an important

influence on patients’ health outcomesinfluence on patients’ health outcomes Patients either have positive or negative reaction to Patients either have positive or negative reaction to

how physicians lead their treatmenthow physicians lead their treatment Sense of comfort Optimism/Pessimism about treatment Functioning better from physiological and

behavioral aspects More information collection and conversation relate to More information collection and conversation relate to

better health statusesbetter health statuses

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SummarySummary Technology is more capable than ever for Technology is more capable than ever for

providing patients with access to online recordsproviding patients with access to online records Medical records are more convenient accessed Medical records are more convenient accessed

through the Web, mobile devices, mostly helpful through the Web, mobile devices, mostly helpful for patientsfor patients

Patients review records multiple times and have Patients review records multiple times and have assistance of others for comprehension and assistance of others for comprehension and progressprogress

Disruption is little to none for access granted to Disruption is little to none for access granted to patients while continuing clinical operationspatients while continuing clinical operations