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Hannah Nelson


API EHR integrations can support patient centered care by promoting patient reported outcomes data sharing with primary care providers.


Application programming interface (API) EHR integrations can support patient reported outcomes data sharing with primary care providers, according to a study published in JAMIA.

In a prior feasibility study, researchers developed and tested an initial prototype of a remote patient monitoring application for asthma patients in pulmonary subspecialty clinics. The original intervention consisted of a smartphone app that prompted patients to report asthma symptoms every week. The study demonstrated high patient adherence and low provider burden.

Increased access to patient reported outcomes data can aid providers in delivering patient-centered care.

For the current study, researchers adapted the intervention to the primary care setting and gathered patient and PCP feedback on requirements for a successful remote patient monitoring application.

The study’s results are based on 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.

PCP-facing requirements included a clinician-facing dashboard accessible from the EHR and an EHR inbox message preceding the visit. Nurse-facing requirements included callback requests sent as an EHR inbox message.

Patient-facing requirements included the ability to complete a one- or five-item symptom questionnaire each week, depending on asthma control. Patients also called for the option to request a callback, and the ability to enter notes. Additionally, patients suggested that the app push tips prior to a PCP visit. Requirements were consistent for English- and Spanish-speaking patients.

EHR integration of the intervention required the use of custom APIs, the authors noted.

“This study demonstrates how third-party apps can be used for PRO-based between-visit monitoring in a real-world clinical setting with the goal of maximizing use, usability, and scalability in parallel with native EHR functionality and patient portal offerings,” the study authors wrote.

“Although we focused exclusively on asthma, these findings may generalize to other chronic conditions that benefit from routine symptom monitoring using standardized PROs, such as rheumatologic disease, mental health illness, and irritable bowel disease,” they continued.

Additionally, the authors noted that their study’s findings could be applied more broadly to support primary care patient reported outcomes for patients with multiple chronic illnesses.

“Similar requirements elicitation approaches also have the potential to develop scalable interventions for monitoring overall health of patients with multiple chronic conditions, such as captured by global health PROs which measure general physical, mental, and social health,” they wrote.

“With further testing, iterative development, and continued attention to scalability, the rapidly evolving efforts of digital remote monitoring between visits may be achievable at the population level for patients with chronic conditions,” the authors continued.

As care is increasingly delivered remotely, such requirements are likely to become more important.

“Our effort is distinct from other reported efforts at developing clinically integrated remote monitoring interventions, which lack prioritization of requirements, require additional clinical staff, such as care managers, to monitor data, or require a device,” the authors wrote.

These alternate approaches may encounter scalability issues, such as cost challenges for using devices where they aren’t necessary, they explained.

“Furthermore, we provide new knowledge regarding how a third-party application can be integrated into an EHR with patient- and provider-facing components to enable the use of PROs for between-visit monitoring.”