Birds of a Feather PHR

1. Birds of a FeatherPHR HL7 - Phoenix Tuesday, Q5 EHR/PHR WG John Ritter, Elaine Ayres, Tim Mckay

2. Agenda • Introduction and Welcome • High-level display of the new PHR-S FM functions for nutrition and physical activity • The PHR and Mobile Health • Nutrition, PHR, EHR, and Mobile Devices -- The Future is Now! • Q&A, Status, Issues, and Next Steps

3. Description of the Nutrition and Diet Information Section • Nutrition is related to health and wellness as well as chronic diseases. People want to record and monitor their food and nutrient intake including any nutritional supplements because they are trying to manage their weight, maintain their fitness level, or demonstrate progress towards the goals in their nutrition care plan.

4. Examples of Nutrition & Diet Information • Food and nutrient intake records • Liquid nutrition supplements (nutraceuticals) • Enteral and parenteral feedings • Vitamin, mineral and herbal supplements • History of breastfeeding • Diet recommendations provided by a Registered Dietitian • Tracking information such as weight, height, and Body Mass Index (BMI) • Food allergies and intolerances • Physical activity records

5. Criteria 1 • 1a. The system SHALL provide the ability for the PHR Account Holder to manage information regarding the PHR Account Holder's nutrition and/or diet. • 1b. The system SHALL provide the ability for the PHR Account Holder to manage concerns (either self-generated concerns or concerns that were expressed by others) that relate to the PHR Account Holder's nutrition and/or diet.

6. Criteria 2 • 2a. The system SHOULD provide the ability for the PHR Account Holder to capture his or her nutrition and diet information (specifically, current intake of foods and/or nutrients). 2b. The system SHOULD provide the ability for the PHR Account Holder to capture his or her nutrition and diet information (specifically, past history of intake of foods and/or nutrients (e.g., anorexic during teenage years; vegetarian from age 5 to 10). 2c. The system SHALL provide the ability for the PHR Account Holder to import diet and nutrition -related data from a provider's EHR system or from other sources (e.g., diet-related instructions from a provider; diet-related orders; or diet-related information that appears on an assessment).

7. Criteria 3 • 3. PHR system SHOULD allow for entry and tracking of nutritional supplements, multivitamin and herbal products as discrete data or lists. • Question – should this be merged with other medication functionality?

8. Other Criteria • Analyze drug-herb interactions and render a notification or alert • Analyze and render nutritional information by calculating nutrient values for items or total daily intake summaries • Exchange food intake information and/or nutritional analysis data with third-party applications • Capture, maintain, and render physical activity information including total workout data • Capture, maintain, and render educational information

9. Use Case 1 • The PHR-S maintains a food and nutrition history list that may be followed by the PHR Account Holder and referenced by his or her providers and Registered Dietitians. • Copies of the PHR food and nutrition history list may be kept by their providers in their EHRs.

10. Use Case 2 • The PHR-S maintains a list of nutrition and diet-related information including food intake records, nutrient analysis summary records, energy balance data and nutrition care recommendations. • This list may be followed by the PHR Account Holder and referenced by his or her providers including a Registered Dietitian

11. The PHR and Mobile Health • The PHR/Mobile Gap Analysis Sub-group was established to determine the extent of changes needed in the PHR-S Functional Model to accommodate the use of mobile devices within the model. • Scope: • Review recently balloted PHR-S functional model to determine how the introduction of mobile devices as actors within the model may result in changes to the model. • Make specific recommendations to the PHR-S functional model in terms of additional conformance criteria and/or creation of a mobile-specific profile for the PHR-S.

12. PHR/Mobile: Completed Work • The team has generated a bulleted list of issues to use in determining the need for changes to the PHR-S. • Items fall into three overlapping categories • Device characteristics (location services, camera, accelerometer, screen size) • Device context (location of use, BYOD, destination vs. conduit) • User actions (shared devices, device misplacement)

13. PHR/Mobile: Next Steps • Review the PHR-S Chapter 3 conformance criteria to determine need for new/updated criteria. • Consider the need for a mobile-specific PHR-S profile in light of the Chapter 3 review.

14. The PHR and Mobile Applications Mobile optimized page vs. mobile application 85% of US adults own a cell phone – of those 53% own smart phones

15. What if……… • Your smart phone is your PHR? • Utilize various applications • Collect data (or information) from various apps and transfer to the mobile PHR • PHR then provides reminders, suggestions or calculations • PHR enables transfer to other systems

16. How Many Apps? • According to MobileWalla (this morning) • 13,110 Health Apps • 475 Diet and Nutrition Apps • 3534 Exercise and Physical Activity Apps • 574 PHR Apps!! • My Fitness Pal has over 30 million users • 19% of all smart phone users have a health app and of those exercise, diet and weight apps are the most popular (Pew Internet) 11/12

17. Mobile Phones • Phones – texting reminders like Text4Baby • Low and Middle Income Countries (LMIC) • Often mobile phone only source of information • Use for notifications • Use for reminders

18. Smart Phones • Weight Management Use Case • Establish a goal for weight and body mass index in the weight management app • Record weight data on a weekly basis • NOTE: may use a smart scale to provide weight data directly to app • Record daily food intake in a “diet” app • Monitor daily caloric intake • Collect data in PHR (or PHR app) • PHR provides educational information on weight loss tips and behavior modification

19. Smart Phones • Shopping Use Case • A Diabetes management app develops a shopping list with suggested foods • An embedded bar-code reader captures all of the foods purchased • A list of foods purchased is recorded and sent to the PHR • The Registered Dietitian reviews the list of food purchased as a way to monitor compliance

20. Smart Phones • Vitamin/Mineral/Herbal Supplement Use Case • A supplement tracking app records use of vitamins, mineral and herbal supplement use • The list of compounds used is added to the PHR • The PHR sends the list to the EHR • Prior to upcoming surgery, patient notified to discontinue herbal supplement use based on adverse impact on anesthesia

21. Smart Phones • Physical Activity Use Case • Physical activity app measures daily exercise routines • Point of care testing for blood glucose tracks daily blood sugar levels • Data is transferred to PHR • PHR correlates and graphs relationship of exercise in managing blood glucose levels

22. Smart Phones • Allergy and Intolerance Use Case • Junior eats some nuts at home and develops a rash around his mouth • Mom takes a picture with her phone and sends to her PHR app • Mom heads to the emergency room where an allergy to nuts is added to Junior’s allergy list • The allergy list is then updated in the PHR and includes the associated reaction photo

23. In Closing…. • Q and A • Status of project • Next steps