A Patient-Centered Mobile Health System That Supports Asthma Self-Management (breathe): Design, Development, and Utilization.

BACKGROUND: Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. OBJECTIVE: The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM) platform (breathe) using content based on international evidence-based clinical guidelines. METHODS: We designed and developed breathe as a Web-based mobile health (mHealth) platform accessible on smartphones, tablets, or desktop with user-centered design methods and International Organization for Standardization-certified quality development processes. Moreover, breathe was envisioned as a multifunctional, CSM mHealth platform, with content based on international clinical practice guidelines and compliant with national privacy and security specifications. The system enabled CSM (patient, provider, and breathe) and self-monitoring of asthma patients through (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. The data collection protocol collected user data for 12 months, with clinic visits at baseline and 6 and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use, asthma symptom profile, reported peak flow measurement, and the delivery and impact of email reminders. RESULTS: We enrolled 138 patients with a mean age of 45.3 years to receive the breathe intervention. Majority were female (100/138, 72.5%), had a smartphone (92/138, 66.7%), and had a mean Asthma Control Test score of 18.3 (SD 4.9). A majority reported that breathe helped in the management of their asthma. Moreover, breathe scored 71.1 (SD 18.9) on the System Usability Scale. Overall, 123 patients had complete usage analytics datasets. The platform sent 7.96 reminder emails per patient per week (pppw), patients accessed breathe 3.08 times, journaled symptoms 2.56 times, reported medication usage 0.30 times, and reported peak flow measurements 0.92 times pppw. Furthermore, breathe calculated patients' action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 47.71% (8300/17,396) of the total calculations. Usage analysis showed that 67.5% (83/123) of the participants used the app at week 4 and only 57.7% (71/123) by week 45. Physician visits, email reminders, and aged 50 years and above were associated with higher utilization. CONCLUSIONS: Individuals with asthma reported good usability and high satisfaction levels, reacted to breathe notifications, and had confidence in the platform's assessment of asthma control. Strong utilization was seen at the intervention's initiation, followed by a rapid reduction in use. Patient reminders, physician visits, and being aged 50 years and above were associated with higher utilization. TRIAL REGISTRATION: ClinicalTrials.gov NCT01964469; https://clinicaltrials.gov/ct2/show/NCT01964469.

Examining nursing vital signs documentation workflow: barriers and opportunities in general internal medicine units.

AIMS: To characterise the nursing practices of vital signs collection and documentation in a general internal medicine environment to inform strategies for improving workflow design. BACKGROUND: Clinical workflow analysis is critical to identify barriers and opportunities in current processes. Analysis can guide the design and development of novel technological solutions to produce greater efficiencies and effectiveness in healthcare delivery. Research surrounding vital signs documentation workflow in general internal medicine environments has received very little attention making it difficult to compare the effectiveness of new technologies. DESIGN: Qualitative ethnographic analyses and quantitative time-motion study were conducted. METHODS: Workflows of 24 nurses at three hospitals in five general internal medicine environments were captured, and timeliness of vital signs assessment and documentation was measured. RESULTS: Clinical assessment of vital signs was consistent, but the documentation process was highly variable within groups and between hospitals. Two themes characterised workflow barriers surrounding point-of-care documentation. First, a lack of standardised documentation methods for vital signs resulted in higher rates of transcription, increasing not only the likelihood of errors but delays in recording and accessibility of information. Second, despite advancements in electronic documentation systems, the observed system was not conducive to point-of-care documentation. Average electronic documentation was significantly longer than paper documentation. Nurses developed ad hoc workarounds that were inefficient and undermined the intent of electronic documentation. CONCLUSION: We have identified barriers and opportunities to improve the efficiency of nursing vital signs documentation. Changes in technology, workflows and environmental design allow for significant improvements and deserve further exploration. RELEVANCE TO CLINICAL PRACTICE: Attention to clinical practice and environments can improve the workflow of prompt vital signs documentation and increase clinical productivity and timeliness of information for clinical decisions, as well as minimising transcription errors leading to safer patient care.