A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems

S. Marceglia; P. Fontelo; E. Rossi; MJ Ackerman

doi:10.4338/ACI-2014-12-RA-0115

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2015; 06(03): 488-505
DOI: 10.4338/ACI-2014-12-RA-0115

Research Article

Schattauer GmbH

A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems

Autoren

S. Marceglia

¹Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine, Bethesda, MD 20994, USA

²Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersFondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
P. Fontelo

¹Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine, Bethesda, MD 20994, USA
E. Rossi

³eHealthLAB, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
MJ Ackerman

¹Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine, Bethesda, MD 20994, USA

Abstract

Summary

Summary Background: Mobile health Applications (mHealth Apps) are opening the way to patients’ responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient’s access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated “island systems”.

Objective: Although much work has been done on patient’s access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care.

Methods: Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform.

Results: The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 – CDA2). In the process, the clinician “prescribes” the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage.

Conclusions: The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient’s engagement in self-management and self-care.

Citation: Marceglia S, Fontelo P, Rossi E, Ackerman MJ. A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems. Appl Clin Inform 2015;6: 488–505

http://dx.doi.org/10.4338/ACI-2014-12-RA-0115

Keywords

Mobile health - delivery of health - heart failure

Volltext

Referenzen

References
1 Marceglia S, Bonacina S, Zaccaria V, Pagliari C, and Pinciroli F. “How might the iPad change health-care?,”. J R Soc Med 2012; 105 (Suppl. 06) 233-241.
2 Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, and Gu D. “Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis: Mobile phone intervention and glycaemic control,”. Diabet Med 2011; 28 (04) 455-463.
3 Pal K, Eastwood S.V, Michie S, Farmer A, Barnard M. L, Peacock R, Wood B, Edwards P, and Murray E. “Computer-Based Interventions to Improve Self-management in Adults With Type 2 Diabetes: A Systematic Review and Meta-analysis,”. Diabetes Care 2014; 37 (06) 1759-1766.
4 Neubeck L, Lowres N, Benjamin E. J, Freedman S. B, Coorey G, and Redfern J. “The mobile revolution-using smartphone apps to prevent cardiovascular disease,”. Nat Rev Cardiol. 2015
5 Huckvale K, Car M, Morrison C, and Car J. “Apps for asthma self-management: a systematic assessment of content and tools,”. BMC Med 2012; 10: 144.
6 Ricciardi L, Mostashari F, Murphy J, Daniel J. G, and Siminerio E. P. “A national action plan to support consumer engagement via e-health,”. Health Aff Proj Hope 2013; 32 (Suppl. 02) 376-384.
7 Burki T.K. “Cancer apps,”. Lancet Oncol 2013; 14 (07) 580-581.
8 Ozdalga E, Ozdalga A, and Ahuja N. “The smartphone in medicine: a review of current and potential use among physicians and students,”. J Med Internet Res 2012; 14 (05) e128.
9 Censi F, Mattei E, Triventi M, and Calcagnini G. “Regulatory frameworks for mobile medical applications,”. Expert Rev Med Devices 2015; 1-6.
10 Bonacina S, Marceglia S, and Pinciroli F. “A Pictorial Schema for a Comprehensive User-oriented Identification of Medical Apps,”. Methods Inf Med 2014; 53 (03) 208-224.
11 Marceglia S, Fontelo P, and Ackerman M. J. “Transforming consumer health informatics: connecting CHI applications to the health-IT ecosystem,”. J Am Med Inform Assoc JAMIA. 2015
12 The Office of the National Coordinator for Health Information Technology, “Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure,”. 2014
13 Williams C, Mostashari F, Mertz K, Hogin E, and Atwal P. “From The Office Of The National Coordinator: The Strategy For Advancing The Exchange Of Health Information,”. Health Aff (Millwood) 2012; 31 (Suppl. 03) 527-536.
14 Blumenthal D, and Tavenner M. “The ‘meaningful use’ regulation for electronic health records,”. N Engl J Med 2010; 363 (Suppl. 06) 501-504.
15 Barbarito F, Pinciroli F, Mason J, Marceglia S, Mazzola L, and Bonacina S. “Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region,”. J Biomed Inform 2012; 45 (04) 736-745.
16 International Standard Organization, “ISO 13606 –Health Informatics –Electronic health record communication.”. 2008
17 Kaelber D, and Pan E. C. “The value of personal health record (PHR) systems,”. AMIA Annu Symp Proc AMIA Symp AMIA Symp 2008; 343-347.
18 Greenhalgh T, Hinder S, Stramer K, Bratan T, and Russell J. “Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace,”. BMJ 2010; 341: c5814.
19 King D, Lee H, and Darzi A. “Abandoned HealthSpace. Smart phones may help,”. BMJ 2010; 341: c7216.
20 Dean Stephens. “Google Health Shutting Down Doesn’t Mean Google Has Abandoned Health.”. 2011
21 Ackerman M.J. “Computer briefs: Blue Cross, Blue Shield, Blue Button,”. J Med Pract Manag MPM 2013; 28 (06) 394-395.
22 Wiljer D, Urowitz S, Apatu E, DeLenardo C, Eysenbach G, Harth T, Pai H, Leonard K. J. and Canadian Committee for Patient Accessible Health Records (CCPAEHR) “Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies,”. J Med Internet Res 2008; 10 (04) e34.
23 Integrating the Healthcare Enterprise, “IHE Patient Care Coordination (PCC) Technical Framework.”. 2013
24 Fernández-Alemán J.L, Señor I C, Lozoya P. Á. O, and Toval A. “Security and privacy in electronic health records: a systematic literature review,”. J Biomed Inform 2013; 46 (03) 541-562.
25 Daglish D, and Archer N. “Electronic Personal Health Record Systems: A Brief Review of Privacy, Security, and Architectural Issues,”. 2009: 110-110.
26 Valdez R. S, Holden R. J, Novak L. L, and Veinot T. C. “Transforming consumer health informatics through a patient work framework: connecting patients to context,”. J Am Med Inform Assoc JAMIA. 2014
27 Koh H.K, Brach C, Harris L. M, and Parchman M. L. “A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care,”. Health Aff Proj Hope 2013; 32 (02) 357-367.
28 McDonald K.M, Bryce C.L, and Graber M. L. “The patient is in: patient involvement strategies for diagnostic error mitigation,”. BMJ Qual Saf 2013; 22 (02) ii33-ii39.
29 Bosch J, and Molin P. “Software architecture design: evaluation and transformation,”. 1999: 4-4.
30 Askari M, Westerhof R, Eslami S, Medlock S, de Rooij S.E, and Abu-Hanna A. “A combined disease management and process modeling approach for assessing and improving care processes: A fall management case-study,”. Int J Med Inf. 2013
31 Mohammed-Rajput N.A, Smith D.C, Mamlin B, Biondich P, Doebbeling B.N. and Open MRS Collaborative Investigators “OpenMRS, a global medical records system collaborative: factors influencing successful implementation,”. AMIA Annu Symp Proc AMIA Symp AMIA Symp 2011; 2011: 960-968.
32 Seebregts C. J, Mamlin B. W, Biondich P. G, Fraser H. S. F, Wolfe B. A, Jazayeri D, Allen C, Miranda J, Baker E, Musinguzi N, Kayiwa D, Fourie C, Lesh N, Kanter A, Yiannoutsos C.T, Bailey C. and OpenMRS Implementers Network “The OpenMRS Implementers Network,”. Int J Med Inf 2009; 78 (Suppl. 11) 711-720.
33 Allen C, Jazayeri D, Miranda J, Biondich P.G, Mamlin B.W, Wolfe B.A, Seebregts C, Lesh N, Tierney W. M, and Fraser H. S. F. “Experience in implementing the OpenMRS medical record system to support HIV treatment in Rwanda,”. Stud Health Technol Inform 2007; 129 (01) 382-386.
34 Boaz M, Hellman K, and Wainstein J. “An automated telemedicine system improves patient-reported well-being,”. Diabetes Technol Ther 2009; 11 (03) 181-186.
35 Earle K.A, Istepanian R.S.H, Zitouni K, Sungoor A, and Tang B. “Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study,”. Diabetes Technol Ther 2010; 12 (07) 575-579.