Remote monitoring of rheumatoid arthritis (RA) has uniquely integrated daily patient-generated health data (PGHD) from smartphones into the EHR, according to findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians, and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. Acceptability and feasibility were assessed with 20 RA patients and 2 clinicians over 3 months. Among the findings:
- Patients submitted data on a median of 91% days over 3 months.
- Qualitative analysis generated 3 themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centered consultations.
- Graphs of patients’ daily data identified real-time changes in disease activity that may have otherwise been missed.
Austin L, et al. Providing ‘the bigger picture’: Benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record. Rheumatology. [Published online ahead of print July 23, 2019]. doi: 10.1093/rheumatology/kez207.
Remote monitoring of patients with RA using patient-generated health data has the potential to greatly improve RA treatment, as patients may forget or under-report symptoms at interval follow-up visits. This study looked at a smartphone app (not commercially available) to evaluate pain, fatigue, AM stiffness, well-being, function, and self-assessed tender and swollen joints, among other measures. 8-26 patients participated in the three rounds of the study and were interviewed along with clinicians afterwards on their perception of remote monitoring. Patients were able to enter data regularly and providers were able to interpret data using graphical analysis provided by the app. Interviews provided qualitative evidence that patients appreciated the resultant patient-centeredness of scheduled visits. The widespread usability of PGHD and a smartphone app would require infrastructure to help patients as well as providers in order to link the data appropriately to patients’ charts and the app itself was only piloted for a short period of time. If scalable to a larger population of patients over a longer period of time, it has the potential to improve comprehensiveness of RA care. —Arundathi Jayatilleke, MD