Design of tools and programs that use PGHD captured via mHealth for SSI surveillance should address the new complexities presented to workflow, IT integration, and communication. This includes provider and administrative staff workflows inside and outside the clinic, as well as integration with existing health IT infrastructures.
Using PGHD captured via mHealth for SSI surveillance introduces novel complexities into clinic workflows. Data submitted by patients outside of the clinic must be received, reviewed, and processed by clinic staff or physicians. Response to patient data is also necessary and may require a spectrum of actions, including communicating reassurance, giving detailed care instructions, requesting a return to clinic, or referral for additional care.28 Patients also desire the ability to leverage mHealth tools for two-way communication with their care providers. However, physicians express concern over the possibility that introducing PGHD captured via mHealth for SSI surveillance may require sifting through and responding to large volumes of data, placing an increased burden of time and energy on care providers.46 Involvement of non-physician clinic staff in data triage may reduce the volume of data providers are presented with, but this solution also carries consequences for non-physician workflow. In addition, patients may submit data outside the normal operating hours of the clinic, raising the possibility that data may need to be reviewed during non-work hours. Workflow complications created by the introduction of PGHD captured via mHealth for SSI surveillance can be offset by potential reductions in unnecessary office visits and time spent with patients who do not require treatment.29,47-50 This potential can only be realized if the design of mHealth tools and programs meets the workflow demands of end users.51,52 Successful implementation of these programs relies on their ability integrate into the clinical environments in which they are deployed.15,47,48
Tool and program design for PGHD captured via mHealth for SSI surveillance should address the following workflow related issues:
Current practices for the integration of PGHD into clinical care lack best practices for workflows, responsibilities and assigned roles, and management of data streams.42 Design of mHealth programs and tools should streamline and implement best practices for how, and by whom, clinical and administrative work is carried out. Yet design should remain flexible to accommodate the unique workflow considerations that arise in the specific contexts within which they are implemented.
Providers desire systems that streamline data flow and curate which data points are presented for review. This focus on “relevant” data can meet the need for accurate information on patient status while reducing the potential burden of data volume. Using mHealth for SSI surveillance presents an opportunity to leverage technology to facilitate data triage without simply shifting that burden to non-physician clinical staff. Using knowledge extraction and computer vision methods it may be possible to design tools that risk stratify patient data, so that data requiring physician attention can rise to the top.
Lack of EHR integration impedes what providers can do with PGHD.53 To address this, physicians and other clinic staff create ad-hoc systems to accommodate data access, review, and storage requirements. In addition, current trends in mHealth tool development favor stand-alone products that lack interoperability. mHealth tools designed for interoperability and the capacity to integrate into existing EHR systems will reduce workflow redundancies and facilitate increased uptake and utilizations of these programs.