Mobile Monitoring-Enabled Telehealth for Patients with Complex Chronic Illnesses.

Telehealth has the potential to improve management of poorly controlled chronic diseases relative to clinic-based care alone. Mobile monitoring-enabled technologies could enhance telehealth for chronic illness care. Implementation in practice settings would rely on automated integration of data into the electronic health record (EHR). We describe the integration and visualization of data from four remote monitoring devices into the EHR that is coupled with the evaluation of an evidence-based nurse and pharmacist-led telehealth care model for patients with uncontrolled diabetes and hypertension. Using this new pragmatic infrastructure, clinicians use the EHR to prescribe for patients a suite of devices. Alerts are placed upon the data that notify a clinician when values go above or below set thresholds. These data are visualized in the clinical record and clinicians use the EHR as a tool for efficiently delivering and documenting patient telehealth encounters.

Selecting Mobile Health Technologies for Electronic Health Record Integration: Case Study.

Mobile health (mHealth) technologies, such as wearable devices and sensors that can be placed in the home, allow for the capture of physiologic, behavioral, and environmental data from patients between clinic visits. The inclusion of these data in the medical record may benefit patients and providers. Most health systems now have electronic health records (EHRs), and the ability to pull and send data to and from mobile devices via smartphones and other methods is increasing; however, many challenges exist in the evaluation and selection of devices to integrate to meet the needs of diverse patients with a range of clinical needs. We present a case report that describes a method that our health system uses, guided by a telehealth model to evaluate the selection of devices for EHR integration.

Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments.

BACKGROUND AND PURPOSE: Debate surrounds the theory that foot structure, and more specifically, the attitude of the midfoot as typified by the longitudinal arch, is associated with complaints of pain and injuries of the lower extremity. Recently, two simple clinical measures of arch height, the arch ratio (AR) and the longitudinal arch angle (LAA), have been reported as valid and reliable in the literature. The LAA has been found to approximate the lowest point of the arch during walking and running while the main strengths of the AR are that the measure takes into account foot size and arch mobility. We modified the AR so that the modified AR (mAR) would be measured in a similar fashion as the LAA to investigate if this new measure, which would account for foot size, correlated well with an established measure (LAA) that estimated the behaviour of the arch with walking and running. Also, we hoped to contribute to the literature correlating longitudinal arch height with pain - numeric pain rating scale - and dysfunction - Lower Extremity Functional Scale (LEFS) and Single Assessment Numeric Evaluation (SANE). METHODS: Thirty-five subjects for this prospective correlational study were recruited from a community based outpatient practice that was part of a tertiary care academic medical centre. Reliability and validity of our investigator and of the mAR was first examined. We then examined the correlation of the clinical classification of arch height (high, normal, or low) produced by these two measures with each other. We also explored the correlation of multiple measures of dysfunction and pain with arch height. RESULTS: Intrarater reliability and validity of the LAA showed an intraclass correlation (ICC) of 0.978 and Pearson's correlation coefficient (PCC) of 0.885, respectively. Intrarater reliability and validity of the mAR showed an ICC of 0.961 and PCC of 0.827, respectively. The LAA and our new measure, the mAR, were correlated with each other. The self-report measures of general health and activity level were significantly positively correlated (PCC = 0.598). Also significant and positively correlated were the LEFS and the SANE (PCC = 0.617), two measures of function. CONCLUSIONS: Pain and dysfunction may be positively correlated but longitudinal arch height does not predict either pain or dysfunction.