title: A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice.
abstract: The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology - mobile Post-Operative Wound Evaluator (mPOWEr) - that uses PGHD for post-discharge surgical wound monitoring.
  
  
  
  As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers.
  
  
  
  We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses.
  
  
  
  We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications.
  
  
  
  We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.
authors.affiliation: Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA psanger@uw.edu.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Sanger
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hartzler
authors.affiliation: Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Lordon
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Cheryl Al
authors.initials: CA
authors.lastname: Armstrong
authors.affiliation: Departments of Biobehavioral Nursing and Health Systems, and Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Lober
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Evans
authors.affiliation: Information School and Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, USA.
authors.forename: Wanda
authors.initials: W
authors.lastname: Pratt
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D008991:Monitoring, Physiologic / Q000379:methods*; D057240:Patient Preference; D018802:Patient-Centered Care / Q000458:organization & administration*; D057566:Self Report; D013530:Surgical Wound Infection / Q000628:therapy; D017216:Telemedicine; D060145:Text Messaging; D055815:Young Adult
keywords: dissent and disputes; mobile health; patient engagement; patient-centered care; surgical wound infection