Integrating Data from “Wearables” into EHRs

An increasing number of patients now use wearables to help them track important metrics and better manage their health. Collecting that information, however, is only the first part of the solution.
Transferring health data from the patient’s technology – electronics worn on the body -- to the clinician’s EHR is critical if the information is to be effectively incorporated into the patient care delivery and care management process.
The Oct. 24, 2017 MGMA Stat poll, with 1,104 responses, asked respondents if they “Would “prescribe” consumer wearables if EHR could integrate data? While a small number (6%) of respondents replied they, “already do,” 35% responded “Yes” and another 41% were “unsure.” Just 18% responded “no.” While a minority of practices currently “prescribe” wearables to their patients, the data suggests a significant number are interested in adding this functionality.
Before practices can take full advantage of these new sources of data, issues such as unreliable data quality, increased security risks, and system interoperability must be addressed. The following are action steps practices should consider for incorporating wearable data into an EHR.
Ten action steps: Incorporating data from patient wearables into an EHR

1. Establish if your patient population would benefit. Those with ongoing primary care relationships (e.g., family medicine, pediatrics, gerontology) and those with certain ongoing chronic care relationships (e.g., cardiology, endocrinology, rheumatology, pulmonology) may be more likely to realize the value of an interface between wearables and health tracking apps and an EHR.
2. Discuss availability and cost with your EHR vendor. Determine if your EHR vendor offers an interface with wearable devices. How will the system incorporate external data into the patient’s medical record, and how will the clinicians see the information displayed? Can the vendor analyze and correlate the information or have a recommendation for a third-party application? Also, determine the upfront and ongoing costs to the practice for implementing a wearable device interface. 
3. Consider targeting certain patients. Patients with chronic conditions such as diabetes and those focused on weight-loss may be the best candidates for wearable-EHR interfacing. Capturing data such as blood sugar levels, daily steps taken, and weight can link a patient activity with health outcomes more effectively.
4. Determine the implications on clinical workflow. Once data from wearables is imported into the EHR (potentially in voluminous amounts), the practice must decide who will review and make a determination on next steps. Does the data warrant, for example, a follow-up call from clinical personnel or the scheduling of an appointment?
5. Review care coordination opportunities. Practices increasingly are participating in pay-for-performance programs such as Patient-Centered Medical Homes and accountable care organizations that reward care coordination and improved patient outcomes. Managing patients with chronic illnesses and identifying patients with emerging health issues is imperative. Customizing treatment plans based on data analytics better positions the organization for success in these new payment models.
6. Leverage wearables when participating in MIPS with 2015 CEHRT. The Advancing Care Information component of the Merit-based Incentive Payment System (MIPS) permits clinicians to count patient-generated data toward their performance score, but only when using 2015 Edition Certified Electronic Health Record Technology (CEHRT).
7. Test the reliability of the data. If data from wearables is to be relied on during staff decision-making, it is imperative that clinicians have confidence in its reliability. As a test, have patients on occasion transmit data such as weight or blood sugar level right before an appointment, and then match those numbers with what is captured during the appointment by practice staff.   
8. Recognize and address security risks. Receiving data from any external source comes with an increased risk of unauthorized disclosure. Practices, as part of their required HIPAA Security Risk Analysis, should assess and document the risks associated with transmitting data from wearables to an EHR, -and how those risks were mitigated.
9. Engage patients. Engaging patients will maximize the opportunities afforded by incorporating wearable data into your clinical workflow. Remind patients that self-tracking key health metrics, especially with the aid of a wearable device, can allow them to be better stewards of their healthcare.
10. Market your capabilities. In a competitive physician practice economic environment, marketing your ability to engage patients with the use of consumer technology can be an important market differentiator, particularly with younger patients and those with chronic illnesses.

Consumer wearable devices will become more sophisticated and further empower patients to be the suppliers of health data. To keep up with this trend, physician practices can explore opportunities to incorporate this cutting-edge technology into their care delivery processes. 


Robert Tennant
Director, Health Information Technology Policy 
MGMA

Brendan Fitzgerald
Research Director 
HIMSS Analytics