title: Integrating telehealth care-generated data with the family practice electronic medical record: qualitative exploration of the views of primary care staff.
abstract: BACKGROUND
  Telehealth care is increasingly being employed in the management of long-term illness. Current systems are largely managed via "stand-alone" websites, which require additional log-ons for clinicians to view their patients' symptom records and physiological measurements leading to frustrating delays and sometimes failure to engage with the record. However, there are challenges to the full integration of patient-acquired data into family physicians' electronic medical records (EMR) in terms of reliability, how such data can best be summarized and presented to avoid overload to the clinicians, and how clarity of responsibility is managed when multiple agencies are involved.
  
  
  OBJECTIVE
  We aimed to explore the views of primary care clinicians on the acceptability, clinical utility, and, in particular, the benefits and risks of integrating patient-generated telehealth care data into the family practice EMR and to explore how these data should be summarized and presented in order to facilitate use in routine care.
  
  
  METHODS
  In our qualitative study, we carried out semi-structured interviews with clinicians with experience of and naïve to telehealth care following demonstration of pilot software, which illustrated various methods by which data could be incorporated into the EMR.
  
  
  RESULTS
  We interviewed 20 clinicians and found 2 overarching themes of "workload" and "safety". Although clinicians were largely positive about integrating telehealth care data into the EMR, they were concerned about the potential increased workload and safety issues, particularly in respect to error due to data overload. They suggested these issues could be mitigated by good system design that summarized and presented data such that they facilitated seamless integration with clinicians' current routine processes for managing data flows, and ensured clear lines of communication and responsibility between multiple professionals involved in patients' care.
  
  
  CONCLUSIONS
  Family physicians and their teams are likely to be receptive to and see the benefits of integrating telehealth-generated data into the EMR. Our study identified some of the key challenges that must be overcome to facilitate integration of telehealth care data. This work particularly underlines the importance of actively engaging with clinicians to ensure that systems are designed that align well with existing practice data-flow management systems and facilitate safe multiprofessional patient care.
authors.affiliation: eHealth Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Davidson
authors.forename: Colin R
authors.initials: CR
authors.lastname: Simpson
authors.forename: George
authors.initials: G
authors.lastname: Demiris
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
keywords: data management; family practice; telehealth care