Health Care Division, RAND Corporation, Boston, Massachusetts, USA.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2021 Oct 12;28(11):2433-2444. doi: 10.1093/jamia/ocab157.
To determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers.
Guided by the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, we conducted a user-centered design process involving English- and Spanish-speaking patients and providers affiliated with an academic medical center. We conducted a secondary analysis of interview transcripts from our prior study, new design sessions with patients and primary care providers (PCPs), and a survey of PCPs. We determined EHR integration requirements as part of the asthma app design and development process.
Analysis of 26 transcripts (21 patients, 5 providers) from the prior study, 21 new design sessions (15 patients, 6 providers), and survey responses from 55 PCPs (71% of 78) identified requirements. Patient-facing requirements included: 1- or 5-item symptom questionnaires each week, depending on asthma control; option to request a callback; ability to enter notes, triggers, and peak flows; and tips pushed via the app prior to a clinic visit. PCP-facing requirements included a clinician-facing dashboard accessible from the EHR and an EHR inbox message preceding the visit. PCP preferences diverged regarding graphical presentations of patient-reported outcomes (PROs). Nurse-facing requirements included callback requests sent as an EHR inbox message. Requirements were consistent for English- and Spanish-speaking patients. EHR integration required use of custom application programming interfaces (APIs).
Using the NASSS framework to guide our user-centered design process, we identified patient and provider requirements for scaling an EHR-integrated remote symptom monitoring intervention in primary care. These requirements met the needs of patients and providers. Additional standards for PRO displays and EHR inbox APIs are needed to facilitate spread.
确定哮喘患者及其提供者可扩展远程症状监测干预措施的用户和电子健康记录（EHR）集成要求。
在非采用、放弃、扩展、传播和可持续性（NASSS）框架的指导下，我们进行了一项以患者和提供者为中心的设计过程，参与者包括隶属于学术医疗中心的讲英语和西班牙语的患者和提供者。我们对我们之前研究的访谈记录进行了二次分析，与患者和初级保健提供者（PCP）进行了新的设计会议，并对 PCP 进行了调查。我们确定了 EHR 集成要求，作为哮喘应用程序设计和开发过程的一部分。
对先前研究的 26 份转录本（21 名患者，5 名提供者）、21 次新设计会议（15 名患者，6 名提供者）以及 55 名 PCP （78 名中的 71%）的调查回复进行分析，确定了要求。面向患者的要求包括：根据哮喘控制情况，每周进行 1 项或 5 项症状问卷；选择请求回呼；能够输入笔记、触发因素和峰值流量；在就诊前通过应用程序推送提示。面向 PCP 的要求包括可从 EHR 访问的面向临床医生的仪表板和访问前的 EHR 收件箱消息。关于患者报告结果（PROs）的图形表示，PCP 的偏好存在分歧。面向护士的要求包括将回呼请求作为 EHR 收件箱消息发送。英语和西班牙语患者的要求一致。EHR 集成需要使用自定义应用程序编程接口（API）。
使用 NASSS 框架指导我们以患者为中心的设计过程，我们确定了在初级保健中扩展 EHR 集成远程症状监测干预措施的患者和提供者要求。这些要求满足了患者和提供者的需求。需要额外的 PRO 显示和 EHR 收件箱 API 标准来促进传播。
