Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Surg Infect (Larchmt). 2019 Oct;20(7):571-576. doi: 10.1089/sur.2019.195. Epub 2019 Aug 9.
The patient's history of present illness provides an important part of the data with which clinicians diagnose and treat. Once surgical patients are discharged, the ability to incorporate direct observation requires coordinating patient and provider for a clinical visit. Mobile technologies offer the ability to gather and organize the patient's history, supplement that history with photographs and other clinical observations, and convey those data accurately and rapidly to the entire clinical team. We review our experience with patient-generated health data in surgical site infection, draw parallels with similar work in other domains, and identify principles we have found useful. Health information system implementations require substantial changes in provider workflow. Shared expectations between the patient and the surgical team, an incremental approach to change in clinical processes, and an emphasis on clinical utility all support successful implementation. The data collection and rapid information exchange afforded by monitoring post-operative, post-discharge patients using mobile technologies can support the expectations of both patients and providers and may provide a novel data source for public health surveillance of surgical site infection. Both uses of these data require careful attention to introducing changes in clinical workflow.
患者的现病史提供了临床医生诊断和治疗的重要数据。一旦手术患者出院,就需要协调患者和医务人员进行临床访问,以便直接观察。移动技术提供了收集和组织患者病史、用照片和其他临床观察结果补充病史,以及准确、快速地向整个临床团队传达这些数据的能力。我们回顾了我们在手术部位感染患者生成健康数据方面的经验,与其他领域的类似工作进行了比较,并确定了我们认为有用的原则。健康信息系统的实施需要对提供者的工作流程进行重大改变。患者和手术团队之间的共同期望、对临床流程的渐进式改变,以及对临床实用性的重视,都支持成功的实施。使用移动技术监测术后、出院后患者所提供的数据收集和快速信息交换,可以满足患者和医务人员的期望,并可能为手术部位感染的公共卫生监测提供新的数据源。这些数据的这两种用途都需要仔细注意引入临床工作流程的变化。