Design of tools and programs that use PGHD captured via mHealth for SSI surveillance should acknowledge and account for the work performed by patients outside the healthcare setting. Collection and reporting of patient-generated health data by patients who are most likely in a post-surgical state entails additional burdens on time and energy.
Patient partnership is essential to maximize health outcomes. Patients are responsible for managing their health and carrying forward the recommendations and care plans set forth by the healthcare team.54-57 The utility of PGHD as a surrogate for in-person post-surgical monitoring relies on patient motivation to collect and report data. In order to address issues of patient motivation it is necessary to understand the value patients derive from use of mHealth for SSI surveillance. Success of mHealth programs leveraging PGHD for SSI surveillance rests in part on characterization of, and design accommodations for, the way these technologies impact the work of being a patient.2,34,58,59 Such programs offer benefit to patients in the form of fewer in-office visits, increased confidence in self-management, improved communication with healthcare teams, and reduced anxiety in managing post-operative care. However, collecting and reporting PGHD entails demands on patient time and energy beyond what is currently typical in the post-surgical recovery period. Adoption of new tools necessitates patients devote time to education and training; adequate training is an important factor influencing the production reliable, clinically actionable patient-collected data. Data requested of patients may include symptom reports (e.g., wound redness/drainage, pain level, fever), general health data (e.g., weight, diet, activity level), medication use, wound dressing change, lab results, wound photos, standardized patient reported outcomes measures, and contextual free text data. Patients may experience challenges in data collection if the location of the surgical wound is not easily accessible, is very large, or is cosmetically distressing. It is also the case that patient state of recovery may preclude the ability to self-collect the requested data. In such instances collection and reporting data will require enlisting the aid of a care partner, such as a family member.
Tool and program design for PGHD captured via mHealth for SSI surveillance should address the following patient work related issues:
Outcomes that matter to patients, and their priorities for post-operative care should be included in research conducted on this topic. Outcomes to consider include impact on self-efficacy, travel to and time spent in clinic, ability to communicate with care providers, and overall post-operative care management.
It should not be assumed that patients prioritize SSI prevention and monitoring over other aspects of post-operative recovery. Future work should aim to gain a full understanding of the patient value proposition(s) for mHealth/PGHD in SSI surveillance by direct engagement with a broad range of patients, including those who have and have not experienced post-operative wound complications, as well as patients with varying levels of technological ability.
It is important that functionality of mHealth tools for SSI surveillance are reciprocal in nature, “giving” patients something in return for the increased effort expended in collecting and reporting data. mHealth tools should leverage ancillary features that address the needs and desires expressed by patients. The ability to use an app for a variety of post-operative needs may help overcome the potential barrier to engagement presented by the increased time and energy required by data collection and reporting. Ability to track additional aspects of post-operative recovery, availability of educational materials or discharge instructions, and two-way communication functionality are examples of features that may facilitate engagement.
It should be acknowledged that as patient reported outcomes and patient-generated health data gain traction in other domains, requests for patients to collect and report data outside the clinic are increasing. Siloing of these efforts within disparate domains of healthcare may result in patient response fatigue. Future work should address the potential for leveraging mobile technology to gather such data in an integrated fashion.