Tomorrow's New Vital Signs, PHR-delivered

06/23 - Quick update: Jane Sarasohn-Kahn posted a nice commentary on Health Populi, in which she discusses this latest e-primer and the potential for PHRs to meaningfully track observations in daily living.  Thanks, Jane!

Project HealthDesign has released a new e-primer that explores the importance of observations of daily living (ODL) in moving toward next-generation personal health records and health management.  PHRs enable consumers and providers to incorporate routine health observations that go well beyond what data are captured at clinical visits.  Some are more obvious than others – blood glucose readings for diabetics, did I take the right pills at the right time today – but others may play an equally important role in pursuing health goals and managing chronic health conditions. 

Things like:  Does my chronic pain spike when the temperature dips below a certain threshold?  What effects might a particularly stressful month, with long hours at work and marginal sleep, have on my eating and activity behaviors, and hence my diabetes?  Can the fact that a 17-year-old with a chronic illness is regularly self-reporting his or her mood to be bad or sad play a role in the self-management of his or her disease?  And, if today’s pollen counts are really high, can my PHR device send me an alert in the morning to remember my inhaler, and then delete that point-in-time data capture because it may not be useful if conditions change tomorrow?

The ability to seamlessly capture such observations and show trends over time could add immense value for patients, who are looking to make the smartest decisions that will enable them to feel and function their best on a day-to-day basis.  And it might reveal important patterns to their health care providers, who rarely get a glimpse in to the potential impact that poor sleep, high stress or signs of depression can have on health outcomes over time. 

Jay Sanders, M.D., F.A.C.P., president and CEO of the Global Telemedicine Group, put it this way in the e-primer:

"In the way medicine is traditionally practiced, blood pressure is taken on an apparently healthy person once every year or so, when she visits the doctor. It’s a snapshot in time. What we need instead is not a single measurement at a point in time, but several measurements over time to really assess what her
blood pressure ought to be.  And we need those measurements taken in the right place. A blood pressure reading taken in the doctor’s office is rather ridiculous, because patients don’t live in the doctor’s office. For most  conditions, hypertension certainly being one of them, examining the patient in his or her environment, not in our environment, is better medical care.  This is where a PHR can be of extraordinary value, as a dynamic, living database that is in effect constantly physiologically evaluating us."

Project HealthDesign grantees are breaking new ground in designing smart PHR applications that will draw on relevant ODLs to provide tailored feedback that informs consumers’ daily health decisions.  And the program as a whole is determining how best to do this, so that ODL data provide meaningful indicators to patients and providers, and not just add data “noise” to the management of chronic conditions.  The grantee teams are gathering in DC this week to share their latest learnings, and we’ll have more to report to the blog mid-week about what they say.