ROAMM-EHR: Pilot Trial of a Real-Time Symptom Surveillance System for Post-Discharge Surgical Patients

项目摘要 近年来，移动的健康（mHealth）应用程序承诺改善对健康状况的监测， 改善临床结果。虽然现有的传感器和设备收集来自患者的相关信息， 信息很少与保健提供者分享，可能妨碍及时干预。现有 患者入口通常是静态的-它们缺乏远程和实时监控能力 症状、药物使用、活动水平和社区流动性。这些信息对于理解 患者如何从手术中恢复-这对于高度近视的老年人尤其如此。 很容易恢复不良。该应用程序的目标是：1）实现我们现有的实时和 在线评估和移动监测（ROAMM）智能手表应用程序平台纳入电子健康记录 (EHR)以形成ROAMM-EHR平台，2）在一项试点随机临床试验（RCT）中测试其可行性， 老年患者（n= 50，>60岁）在准备确定性试验的矫形外科手术后出院。的 中心假设是，将患者生成的健康数据与EHR系统集成将改善症状 管理并延续至更好的结局，例如移动功能、减轻疼痛和提高生活质量 与护理标准相比。其基本原理是，对病人的生态学瞬时评估 症状可以促进更早和更知情的微干预，如改变药物， 加强康复或进行更多的检查，从而改善患者的治疗效果。试点RCT 将实现业务目标，为今后的试验完善和建立若干要素，包括： 使用ROAMM-EHR的入职和行为方法，随机化方案，研究结果， 质量保证和标准化、征聘和保留率、数据分析战略、技术 实施以及患者和工作人员的可用性/可接受性。这种方法是创新的，因为研究将 代表了第一次努力，不仅建立和实施，而且正式测试实时手术后 通过将来自可穿戴设备的患者生成的健康数据与 EHR系统。这项拟议的研究是重要的，因为及时的术后恢复将防止长期- 老年人的短期不良后果。预期的结果是1）启用新的智能手表 症状监测平台，这将有助于术后护理管理和2）必要的 规划确定性试验的知识，以减少移动健康循证医学的主要差距 干预措施。ROAMM-EHR的实施和严格评估在完成后不仅将检验 变革性的临床工具，它将成为公共和私营部门其他人的基础， 利用移动健康应用在医疗保健领域的前景。

Project Summary In recent years, mobile health (mHealth) apps have promised improved monitoring of health conditions to improve clinical outcomes. While existing sensors and devices collect relevant information from patients, such information is rarely shared with healthcare providers, potentially preventing timely interventions. Existing patient portals are typically static in nature— they lack remote and real-time capabilities for monitoring symptoms, medication use, activity levels and community mobility. These is vital information for understanding how patients recover from surgical procedures— this is particularly true for older adults who are highly vulnerable to poor recovery. The objectives of this application are to: 1) implement our existing Real-Time and Online Assessment and Mobility Monitor (ROAMM) smartwatch app platform into the electronic health record (EHR) to form the ROAMM-EHR platform and 2) test its feasibility in a pilot randomized clinical trial (RCT) in older patients (n= 50, >60 yrs) discharged after orthopedic surgery in preparation for a definitive trial. The central hypothesis is that integrating patient generated health data with the EHR system will improve symptom management and carry over into better outcomes, e.g. mobility function, lower pain, and better quality of life indices compared to the standard of care. The rationale is that ecological momentary assessment of patient symptoms can promote earlier and more informed micro-interventions such as changing medications, enhancing rehabilitation or performing more check-ins, resulting in improved patient outcomes. The pilot RCT will accomplish operational aims to refine and establish several elements for the future trial, including: the onboarding and behavioral approaches for using ROAMM-EHR, randomization scheme, study outcomes, quality assurance and standardization, recruitment and retention rates, data analytic strategies, technical implementation, and patient and staff usability/acceptability. The approach is innovative, because study will represent the first effort to not only build and implement but also to formally test a real-time post-surgical symptom surveillance platform by integrating patient generated health data from wearable devices with the EHR system. The proposed research is significant since timely post-surgical recovery will prevent both long- and short-term poor outcomes in older adults. The expected outcomes are 1) a new smart watch enabled symptom surveillance platform that will facilitate post-surgical care management and 2) the necessary knowledge for planning a definitive trial to reduce the major gap of evidence-based medicine for mHealth interventions. At its completion, the implementation and rigorous evaluation of ROAMM-EHR will not only test a transformative clinical tool, it will serve as a foundation for others in both public and private sectors who strive to capitalize on the promise of mHealth apps in healthcare.