Background Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians’ diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. Objective In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of “early adopter” clinicians and patients. Methods Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. Results We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. Conclusions This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care.
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Tedious Versus Taxing: The Nature of Work in a Behavioral Health Context
The goal of this study was to examine the work practices of behavioral health professionals with a view towards designing interactive systems to support their work. We conducted a qualitative workplace study, including in situ observations and semi-structured interviews, in a multidisciplinary clinic treating pediatric feeding disorders. This paper contributes a detailed characterization of clinicians' work practices and conducts a comparative analysis of three types of work: treatment, record management, and preparation work. We found that clinicians have a preference for taxing over tedious work. For example, they experience real-time data collection as more taxing but less tedious than retroactive data entry. Design efforts should balance the tension between addressing the taxing (data collection during meals) versus the tedious (manually entering data into spreadsheets). Although addressing the taxing improves within-routine efficiency, addressing the tedious improves overall morale. Further, we hypothesize that there is a rewarding or unrewarding quality to work that is dictated in part by its social, temporal, and clinical characteristics. We discuss conceptual and design implications for supporting clinical work, and highlight considerations unique to behavioral health.
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- Award ID(s):
- 1816319
- NSF-PAR ID:
- 10332286
- Date Published:
- Journal Name:
- Proceedings of the ACM on Human-Computer Interaction
- Volume:
- 5
- Issue:
- CSCW2
- ISSN:
- 2573-0142
- Page Range / eLocation ID:
- 1 to 24
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1145/3476043
