Feasibility of Electronic Health Record Integration of a SMART Application to Facilitate Patient-Provider Communication for Medication Management

Abstract

Increased treatment complexity in patients with diabetes contributes to medication nonadherence. Patient portals that are accessible through electronic health records may offer improved patient-provider communication and better medication management in patients with diabetes and uncontrolled hypertension. We conducted a prospective, mixedmethods evaluation of the Duke PillBox application, a SMART-on-FHIR medication management application integrated into the electronic health record patient portal. Adults with active portal status, diabetes, and uncontrolled hypertension participated in a usability/feasibility survey and communicated with a pharmacist via the portal-based application who conducted medication reconciliation and discussed medication indications, side effects, and barriers to use with patients. Of the eligible patients (n = 285), 29 (10%) were interested, and 12 (8%) participated. Challenges to usability were due to the electronic health record-portal communication interface (91%), browser access and compatibility (55%), and persistent lists of unused medications in the electronic health record (27%). The findings of this study suggest that electronic health record-integrated medication applications are desirable as indicated in patient interactions at the outset and conclusion of the study. Persistent challenges included electronic health record integration, interoperability, user interface, and browser connectivity for both patients and providers.

Successful Integration of EN/ISO 13606–Standardized Extracts From a Patient Mobile App Into an Electronic Health Record: Description of a Methodology

“…Other groups have reported the use of the SMART on FHIR framework to integrate PGHD from mobile apps into EHRs [30][31][32][33]. This framework enables medical apps to be written once and run unmodified across different health care IT systems and has proven to be an effective approach for interoperability.…”

Strengthening Cybersecurity for Patient Data Protection in Europe

“…Technologies like blockchain [25][26][27] and a community solid server, which furnishes individuals with their personal data storage spaces [28], have been effective in addressing concerns related to patient privacy breaches. Furthermore, technologies such as Fast Healthcare Interoperability Resources (which dictate rules for exchanging electronic health care data) [29][30][31], the Observational Medical Outcomes Partnership Common Data Models (a standardized data format to facilitate consistent analysis of observational data) [32], and cross-enterprise document sharing (enabling cataloguing and sharing of patient records across health care institutions) are also capable of addressing cybersecurity issues tied to electronic health records [33]. Nevertheless, implementing effective cybersecurity measures may come at an additional cost; however, these costs are relatively insignificant compared to the direct costs of cybersecurity threats (mentioned above) and the potential direct and indirect repercussions of exposing the health data of EU citizens to substandard cybersecurity practices [2].…”