Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study

Lynn Austin; Charlotte Sharp; Sabine Van Der Veer; Matthew Machin; John Humphreys; Peter  Mellor; Jillian Mccarthy; John Ainsworth; Caroline Sanders; William Dixon

doi:10.1093/rheumatology/kez207

Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study

Lynn Austin, Charlotte Sharp, Sabine Van Der Veer, Matthew Machin, John Humphreys, Peter Mellor, Jillian Mccarthy, John Ainsworth, Caroline Sanders, William Dixon

Manchester Academic Health Science Centre (MAHSC)

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives
To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record (EHR), using the example of rheumatoid arthritis (RA).

Methods
The Remote Monitoring in RA (REMORA) smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the EHR of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over three months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarised descriptively, and qualitative data were analysed thematically.

Results
Patients submitted data on a median of 91% days over three months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. Themes demonstrated the system helped render patients’ RA more visible by providing the “bigger picture”, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.

Conclusion
REMORA has uniquely integrated daily PGHD from smartphones into the EHR. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

Original language	English
Pages (from-to)	367-378
Number of pages	12
Journal	Rheumatology (Oxford)
Volume	59
Issue number	2
Early online date	23 Jul 2019
DOIs	https://doi.org/10.1093/rheumatology/kez207
Publication status	Published - 23 Jul 2019

Keywords

Data Collection
Electronic Health Records
Feasibility Studies
Focus Groups
Humans
Mobile Applications
Rheumatology
Smartphone

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Centre for Epidemiology Versus Arthritis.
Dixon, W. (PI), Bruce, I. (CoI), Felson, D. (CoI), Hyrich, K. (CoI), Lunt, M. (CoI), Mcbeth, J. (CoI), Mcdonagh, J. (CoI), O'Neill, T. (CoI), Sergeant, J. (CoI), Verstappen, S. (CoI) & Serafimova, I. (Support team)
1/08/18 → 31/07/25
Project: Research

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Austin, L., Sharp, C., Van Der Veer, S., Machin, M., Humphreys, J., Mellor, P., Mccarthy, J., Ainsworth, J., Sanders, C., & Dixon, W. (2019). Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. Rheumatology (Oxford), 59(2), 367-378. https://doi.org/10.1093/rheumatology/kez207

@article{b8adf8f9fa80407da900da90d93828c6,

title = "Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study",

abstract = "ObjectivesTo establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record (EHR), using the example of rheumatoid arthritis (RA). MethodsThe Remote Monitoring in RA (REMORA) smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the EHR of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over three months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarised descriptively, and qualitative data were analysed thematically. ResultsPatients submitted data on a median of 91% days over three months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. Themes demonstrated the system helped render patients{\textquoteright} RA more visible by providing the “bigger picture”, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.ConclusionREMORA has uniquely integrated daily PGHD from smartphones into the EHR. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.",

keywords = "Data Collection, Electronic Health Records, Feasibility Studies, Focus Groups, Humans, Mobile Applications, Rheumatology, Smartphone",

author = "Lynn Austin and Charlotte Sharp and {Van Der Veer}, Sabine and Matthew Machin and John Humphreys and Peter Mellor and Jillian Mccarthy and John Ainsworth and Caroline Sanders and William Dixon",

note = "Funding Information: Funding: This project was funded by Versus Arthritis (formerly Arthritis Research UK) (grant number 21126) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester. Additional support was provided by the Centre for Epidemiology Versus Arthritis (grant reference 20380). The NIHR CLAHRC Greater Manchester is a partnership between providers and commissioners from the NHS, industry and the third sector, as well as clinical and research staff from the University of Manchester. The views expressed in this article are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. Publisher Copyright: {\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2019",

month = jul,

day = "23",

doi = "10.1093/rheumatology/kez207",

language = "English",

volume = "59",

pages = "367--378",

journal = "Rheumatology (Oxford)",

issn = "1462-0324",

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}

Austin, L, Sharp, C , Van Der Veer, S, Machin, M, Humphreys, J, Mellor, P, Mccarthy, J , Ainsworth, J , Sanders, C & Dixon, W 2019, 'Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study', Rheumatology (Oxford), vol. 59, no. 2, pp. 367-378. https://doi.org/10.1093/rheumatology/kez207

Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. / Austin, Lynn; Sharp, Charlotte ; Van Der Veer, Sabine et al.
In: Rheumatology (Oxford), Vol. 59, No. 2, 23.07.2019, p. 367-378.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study

AU - Austin, Lynn

AU - Sharp, Charlotte

AU - Van Der Veer, Sabine

AU - Machin, Matthew

AU - Humphreys, John

AU - Mellor, Peter

AU - Mccarthy, Jillian

AU - Ainsworth, John

AU - Sanders, Caroline

AU - Dixon, William

N1 - Funding Information: Funding: This project was funded by Versus Arthritis (formerly Arthritis Research UK) (grant number 21126) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester. Additional support was provided by the Centre for Epidemiology Versus Arthritis (grant reference 20380). The NIHR CLAHRC Greater Manchester is a partnership between providers and commissioners from the NHS, industry and the third sector, as well as clinical and research staff from the University of Manchester. The views expressed in this article are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. Publisher Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2019/7/23

Y1 - 2019/7/23

N2 - ObjectivesTo establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record (EHR), using the example of rheumatoid arthritis (RA). MethodsThe Remote Monitoring in RA (REMORA) smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the EHR of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over three months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarised descriptively, and qualitative data were analysed thematically. ResultsPatients submitted data on a median of 91% days over three months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. Themes demonstrated the system helped render patients’ RA more visible by providing the “bigger picture”, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.ConclusionREMORA has uniquely integrated daily PGHD from smartphones into the EHR. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

AB - ObjectivesTo establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record (EHR), using the example of rheumatoid arthritis (RA). MethodsThe Remote Monitoring in RA (REMORA) smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the EHR of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over three months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarised descriptively, and qualitative data were analysed thematically. ResultsPatients submitted data on a median of 91% days over three months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. Themes demonstrated the system helped render patients’ RA more visible by providing the “bigger picture”, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.ConclusionREMORA has uniquely integrated daily PGHD from smartphones into the EHR. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

KW - Data Collection

KW - Electronic Health Records

KW - Feasibility Studies

KW - Focus Groups

KW - Humans

KW - Mobile Applications

KW - Rheumatology

KW - Smartphone

UR - http://www.scopus.com/inward/record.url?scp=85078549559&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/kez207

DO - 10.1093/rheumatology/kez207

M3 - Article

C2 - 31335942

SN - 1462-0324

VL - 59

SP - 367

EP - 378

JO - Rheumatology (Oxford)

JF - Rheumatology (Oxford)

IS - 2

ER -

Austin L, Sharp C , Van Der Veer S, Machin M, Humphreys J, Mellor P et al. Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. Rheumatology (Oxford). 2019 Jul 23;59(2):367-378. Epub 2019 Jul 23. doi: 10.1093/rheumatology/kez207

Providing 'the bigger picture': benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study

Abstract

Keywords

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Centre for Epidemiology Versus Arthritis.

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