Patient-centered Mobile Health Application Implementations as a Team Sport: A patient and provider working together to achieve the full potential of health information technology
Background: Surgical site infections are a leading cause of preventable post-operative morbidity, mortality, and health care expenditures. We developed a mobile health (mHealth) application, mPOWEr, to facilitate patient-provider communication regarding the signs and symptoms of surgical site infections post-discharge. During the formative needs assessment of mPOWEr, we found patients and providers may have discordant needs and expectations when using mPOWEr in clinical care. Objective: To apply codes determined through a formative needs analysis of mPOWEr to analyze a patient-centered implementation of mPOWEr from patient and provider perspectives. Methods: Deductive qualitative analysis of a transcribed interview with a patient and a general surgeon discussing their experiences as a dyad about using mPOWEr for remote post-discharge surgical wound management. We used 38 pre-defined codes based on the results of the formative needs assessment of mPOWEr. The 14-minute interview was as an open-ended discussion of the patient’s and provider’s experience. Three coders analyzed the transcript independently using Dedoose and met to resolve coding discrepancies through discussion. Results: We identified three major themes that emerged in the interview. The first theme concerns the implementation and workflows by the physician using mPOWEr. Four instances of the ‘adoption’ code were applied to the transcript. The physician stated, “we’re trying to build in a lot of these things we can do remotely and the app [mPOWEr] is part of that.” The patient also stated, “having a doctor who is motivated with the app is just as important.” Eight instances of the ‘registration’ code were applied. The physician specifically made an effort to train the patient on the mPOWEr and “took him through every step of it.” The physician also modified his workflow to incorporate a daily review of mPOWEr data. The ‘rounding’ code was applied three times and the physician stated, “I looked at the photos as part of my morning routine.” The second theme relates to communication, and six instances of the ‘email’ code were applied. The patient and the physician engaged in regular communication about the state of the patient’s wound and his recovery. The patient stated emailing “was pretty frequent the whole time I think until it closed up.” The third theme concerns emotion and the ‘reassurance’ code was applied five times. The patient stated, “knowing that I’m being watched really is a secure feeling.” Conclusion: Successful patient-centered mHealth implementations require commitment by both patients and providers. The patient and the physician agreed to work together as a team by adopting mPOWEr to manage the patient’s post-surgical wound and communicate on a regular basis, which reassured the patient during his recovery. This work will inform best practices for future implementations of mPOWEr and act as a foundation for future patient-provider implementation dyad interviews.
Authors: Ross Lordon, Ivan Rahmatullah, Brian Do, Nick Robison, Joie Whitney, Sarah Iribarren, William Lober, Heather Evans