Bridging the integration gap between patient-generated blood glucose data and electronic health records.
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2019-07
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Abstract
Telemedicine can facilitate population health management by extending the reach of providers to efficiently care for high-risk, high-utilization populations. However, for telemedicine to be maximally useful, data collected using telemedicine technologies must be reliable and readily available to healthcare providers. To address current gaps in integration of patient-generated health data into the electronic health record (EHR), we examined 2 patient-facing platforms, Epic MyChart and Apple HealthKit, both of which facilitated the uploading of blood glucose data into the EHR as part of a diabetes telemedicine intervention. All patients were offered use of the MyChart platform; we subsequently invited a purposive sample of patients who used the MyChart platform effectively (n = 5) to also use the Apple HealthKit platform. Patients reported both platforms helped with diabetes self-management, and providers appreciated the convenience of the processes for obtaining patient data. Providers stated that the EHR data presentation format for Apple HealthKit was challenging to interpret; however, they also valued the greater perceived accuracy the Apple HealthKit data. Our findings indicate that patient-facing platforms can feasibly facilitate transmission of patient-generated health data into the EHR and support telemedicine-based care.
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Lewinski, Allison A, Connor Drake, Ryan J Shaw, George L Jackson, Hayden B Bosworth, Megan Oakes, Sarah Gonzales, Nicole E Jelesoff, et al. (2019). Bridging the integration gap between patient-generated blood glucose data and electronic health records. Journal of the American Medical Informatics Association : JAMIA, 26(7). pp. 667–672. 10.1093/jamia/ocz039 Retrieved from https://hdl.handle.net/10161/29859.
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Scholars@Duke
Allison A. Lewinski
I am a health services researcher and implementation scientist with a joint appointment at the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA). My expertise spans diabetes distress, qualitative research methods, and virtual care delivery (including telehealth and digital health).
My research examines how virtual care interventions can reduce distress, improve self-management, expand access to evidence-based care, and enhance patient and population health outcomes. I focus on patient-, provider-, and system-level factors that influence the use and effectiveness of virtual care. This work has been funded by competitive grants, published in high-impact journals, presented at national conferences, and used to inform health system decision-making. I am frequently sought by colleagues locally and nationally for expertise in diabetes distress, qualitative methods, and virtual care strategies for grants, projects, and manuscripts.
I strive to improve outcomes for individuals with chronic illness by developing equitable, sustainable virtual care solutions and evaluating their implementation. To optimize these interventions, I apply qualitative and implementation science approaches to ensure alignment among patient needs, care modalities, disease states, and social contexts. My work addresses critical questions: for whom and for what purposes are these interventions effective, in which contexts, and at what points in the care continuum. Ultimately, my research advances the implementation and adoption of virtual care to reduce psychosocial distress and improve health outcomes through patient-clinician interactions and system-level innovations.
Connor David Drake
Connor Drake is a health services researcher and implementation scientist. His research interests are at the intersection of primary care, population health management, social determinants of health, chronic illness care redesign, and virtual care. He has experience with policy analysis, electronic health record data, mixed and multi methods, community engaged research, and implementation and dissemination methods. Dr. Drake's research projects include leveraging telemedicine and other clinical informatics to improve chronic illness care and population health management; developing and implementing behavioral interventions and 'whole-person' care models for patients with cardiovascular disease and metabolic disorders; and studying social care interventions to respond to social risk factors by promoting food security, housing stability, and social support to improve health outcomes.
Dr. Drake currently studies care models that feature food and nutrition security interventions (i.e., ‘Food is Medicine’) for patients at risk of food insecurity and at heightened cardiometabolic risk. This includes developing and testing scalable models for integrating food-based interventions—such as produce prescriptions—into clinical settings, investigating the relationships between food security and cardiometabolic health outcomes, and implementing social needs screening and response programs that promotes food security alongside other social determinants of health. Dr. Drake's research emphasizes implementation science approaches to understand how these ‘Food is Medicine’ programs can be best integrated and scaled across diverse healthcare settings, particularly in Veteran care settings and safety-net systems serving vulnerable populations.
Ryan Shaw
Ryan Shaw serves as the Chief Nurse Innovation Officer for Duke University Health System. By leveraging technology and evidence-based practices, he identifies opportunities to empower nurses to thrive as changemakers, addressing healthcare delivery challenges, improving patient outcomes, and enhancing efficiency.
In his faculty role at the Duke University School of Nursing, he leads research teams driving digital transformation in healthcare. His work has been supported by organizations such as the U.S. National Institutes of Health (NIH) and the National Science Foundation (NSF), among others. He is passionate about mentoring students to become the next generation of health scientists and clinicians.
George Lee Jackson
Areas of expertise: Epidemiology, Health Services Research, and Implementation Science
George L. Jackson, Ph.D., MHA is a healthcare epidemiologist and implementation scientist with a background in health administration. He joined the faculty of the UT Southwestern Medical Center in February of 2023 as a Professor and Director of the Advancing Implementation & Improvement Science Program in the Peter O'Donnell Jr. School of Public Health. He is also currently the initial Interim Chair of the new Department of Health Economics, Systems, and Policy in the O’Donnell School of Public Health. Dr. Jackson has a secondary appointment as a Professor in the UT Southwestern Division of General Internal Medicine and is a member of the Simmons Comprehensive Cancer Center. In addition to his work at UT Southwestern, Dr. Jackson is a Veterans Affairs (VA) Health Systems Research (HSR) Research Health Scientist who works with the VA healthcare systems in both Durham, NC and Dallas, TX. He is the Director of the Implementation and Improvement Science Lab/Core at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Additionally, he is a co-leader of a cooperative effort between the Dallas VA and Advancing Implementation & Improvement Science Program designed to enhance the infrastructure for partnered health services and other research across the Dallas VA and UT Southwestern focused on enhancing the health and healthcare of Veterans in North Texas and across the Nation.
The UT Southwestern Advancing Implementation & Improvement Science Program seeks to further enhance collaborations between the UT Southwestern and affiliated health systems and community partners in the pursuit of common missions to enhance the health and healthcare of the people of North Texas and beyond. The goal is to develop a system to identify potentially successful projects using implementation and improvement science – which uses rigorous, data-driven research to expand programs and improve a community’s health.
Dr. Jackson’s own research and evaluation efforts focus on the development, testing, and implementation of team-based approaches to address the treatment and prevention of chronic conditions such as diabetes, hypertension, and cancer. He has also evaluated efforts to enhance the organization of mental health care. As an implementation scientist, Dr. Jackson studies strategies focused on the adoption and spread of evidence-informed practices across large health systems. He is currently the corresponding principal investigator for three VA program grants focused on the process of identifying, replicating, and spreading innovations across large healthcare systems. These include the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) partnered evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence program, Dynamic Diffusion Network (DDN) QUERI Program, and Building and Evaluating the Innovation Infrastructure Across the VA Mid-Atlantic Health Care Learning Network partnered evaluation initiative, all funded by the VA Quality Enhancement Research Initiative (QUERI).
Dr. Jackson received his Doctor of Philosophy (Ph.D.) in epidemiology, Master of Health Administration (MHA), and Bachelor of Science in Public Health (BSPH) in health policy and administration degrees from the School of Public Health at the University of North Carolina at Chapel Hill. He completed an Agency for Healthcare Research and Quality (AHRQ) pre-doctoral fellowship in health services research at the Cecil G. Sheps Center for Health Services Research and AHRQ post-doctoral fellowship in health services research in the Duke Division of General Internal Medicine and Health Services Research & Development (HSR&D) Center at the Durham VA. He came to UT Southwestern from Duke University, where he was a Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine & Community Health. He also co-taught evidence-based practice in the Duke Physician Assistant (PA) Program. Dr. Jackson currently maintains appointments as an Adjunct Professor of Population Health Sciences at Duke and Adjunct Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Nicole Elise Jelesoff
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