- Patient-generated health data (PGHD) and lifestyle information is a useful addition to EHRs and helps clinicians create tailored preventive care plans for patients, according to new research published in the Journal of the American Board of Family Medicine.
PGHD and patient-entered lifestyle information are especially useful in the primary care setting, the research team said. Primary care is the ideal area in which clinicians can offer preventive care screenings and advice, with most patients expecting their primary care clinicians to help with lifestyle behavior change.
However, research shows that primary care providers only deliver preventive care and council about 18 percent of the time. Lacking infrastructure to inform and support preventive services is the most oft-cited barrier to comprehensive primary care, the researchers reported.
The Integrated Wellness Tool (IWT) presents an opportunity for clinicians to overcome infrastructure barriers. The IWT takes PGHD and combines it with EHR data to create clinical decision support in the areas of nutrition, stress, exercise, depression, sleep, and breathing.
“With improved insurance coverage for preventive services, systems to efficiently identify patients' needs and facilitate delivery of the appropriate education, support, and follow-up resources are necessary,” the research team said.
“The collection of patient-entered lifestyle risk data could facilitate targeted lifestyle discussions between caregiver and patient, and link to order sets to expedite appropriate management and/or behavior change,” the team continued.
The researchers tested the IWT in a single clinic within the Cleveland Clinic Health System. Five clinicians adopted the tool and 863 patients used the tool.
The researchers looked at the number of preventive orders placed in a before and after analysis.
The increase in provider order placement using the tool was modest, at 1.2 percent on average across all potential preventive orders. However, some preventive care orders had a larger increase than others.
Lifestyle suggestions – such as smoking cessation – had a small order increase, as did specialist referrals. This was likely because referrals and lifestyle overhauls are difficult to complete, the researchers explained.
Tests had higher order rates, ranging between 5 and 7 percent.
“Providers were more likely to recommend and patients more likely to complete recommended screening tests than lifestyle interventions,” the research team noted. “The reasons for this are unknown. It may relate to the 1-time nature of screening tests, or a belief that these interventions are more evidence-based or more likely to succeed.”
During qualitative interviews, the researchers found that clinicians did not perceive any new information from the IWT. Nonetheless, clinicians ended up ordering more preventive care measures.
“This behavior might be attributed to new information presented to the provider, or simply to reminding the provider of the condition when it came time to place orders,” the researchers observed.
Although clinicians did not think they learned new information about their patients using the PGHD, the researchers concluded that the information was still useful.
Patients largely approved of the tool, with nearly all (99 percent) reporting that IWT was easy to use. Ninety-six percent of patients did not require help using IWT and 94 percent said that they would use the tool again.
Ninety-two percent of patients stated they think the tool helped their clinicians better understand overall patient wellness, and therefore helped clinicians draw better conclusions about treatment and preventive care.
While the study did not directly test the IWT’s effect on clinical workflow, high usability scores from both patients and providers suggested that the tool does not hinder practice efficiency.
Going forward, the researchers said the IWT and others like it should interact with other patient-facing technologies. Doing so will further engage patients with their own health data, potentially adding in patient education elements.
“Future versions should include a patient portal allowing patients to interact with their results and providing educational information,” the researchers concluded. “This might increase patient activation and improve follow-through with providers' recommendations. In addition, subsequent studies should investigate the long-term effect of such tools on patients' behaviors and health outcomes.”