{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T18:40:37Z","timestamp":1793558437831,"version":"4.5.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"name":"National Institute on Aging, United States of the National Institutes of Health, United States","award":["K23AG049181"],"award-info":[{"award-number":["K23AG049181"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Provider organizations increasingly allow incorporation of patient-generated data into electronic health records (EHRs). In 2015, we began allowing patients to upload data to our EHR without physician orders, which we henceforth call patient-initiated data (PAIDA). Syncing wearable heart rate monitors to our EHR allows for uploading of thousands of heart rates per patient per week, including many abnormally low and high rates. Physician informaticists expressed concern that physicians and their patients might be unaware of abnormal heart rates, including those caused by treatable pathology.<\/jats:p><jats:p>\n          Objective\u2003This study aimed to develop a protocol to address millions of unreviewed heart rates.<\/jats:p><jats:p>\n          Methods\u2003As a quality improvement initiative, we assembled a physician informaticist team to meet monthly for review of abnormally low and high heart rates. By incorporating other data already present in the EHR, lessons learned from reviewing records over time, and from contacting physicians, we iteratively refined our protocol.<\/jats:p><jats:p>\n          Results\u2003We developed (1) a heart rate visualization dashboard to identify concerning heart rates; (2) experience regarding which combinations of heart rates and EHR data were most clinically worrisome, as opposed to representing artifact; (3) a protocol whereby only concerning heart rates would trigger a cardiologist review revealing protected health information; and (4) a generalizable framework for addressing other PAIDA.<\/jats:p><jats:p>\n          Conclusion\u2003We expect most PAIDA to eventually require systematic integration and oversight. Our governance framework can help guide future efforts, especially for cases with large amounts of data and where abnormal values may represent concerning but treatable pathology.<\/jats:p>","DOI":"10.1055\/s-0040-1716538","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T05:33:32Z","timestamp":1602740012000},"page":"671-679","source":"Crossref","is-referenced-by-count":6,"title":["Patient-Initiated Data: Our Experience with Enabling Patients to Initiate Incorporation of Heart Rate Data into the Electronic Health Record"],"prefix":"10.1055","volume":"11","author":[{"given":"Joshua M.","family":"Pevnick","sequence":"additional","affiliation":[{"name":"Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United States"},{"name":"Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaron","family":"Elad","sequence":"additional","affiliation":[{"name":"Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Masson","sequence":"additional","affiliation":[{"name":"Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard V.","family":"Riggs","sequence":"additional","affiliation":[{"name":"Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United States"},{"name":"Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray G.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.7326\/M17-0583","article-title":"Patients contributing to their doctors' notes: Insights from expert interviews","volume":"168","author":"J N Mafi","year":"2018","journal-title":"Ann Intern Med"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.2196\/jmir.8372","article-title":"Patterns in patient access and utilization of online medical records: analysis of MyChart","volume":"20","author":"D A Redelmeier","year":"2018","journal-title":"J Med Internet Res"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/2047-2501-2-3","article-title":"Big data analytics in healthcare: promise and potential","volume":"2","author":"W Raghupathi","year":"2014","journal-title":"Health Inf Sci Syst"},{"issue":"20","key":"ref7","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1056\/NEJMoa1901183","article-title":"Large-scale assessment of a smartwatch to identify atrial fibrillation","volume":"381","author":"M V Perez","year":"2019","journal-title":"N Engl J Med"},{"issue":"03","key":"ref8","first-page":"24","article-title":"The use of symptom diaries in outpatient care","volume":"20","author":"B Hodge","year":"2013","journal-title":"Fam Pract Manag"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/09674845.2012.12002443","article-title":"A history of blood glucose meters and their role in self-monitoring of diabetes mellitus","volume":"69","author":"S F Clarke","year":"2012","journal-title":"Br J Biomed Sci"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"e0165908","DOI":"10.1371\/journal.pone.0165908","article-title":"A large-scale initiative inviting patients to share personal fitness tracker data with their providers: initial results","volume":"11","author":"J M Pevnick","year":"2016","journal-title":"PLoS One"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1161\/CIRCULATIONAHA.110.939249","article-title":"Heart rate response to exercise stress testing in asymptomatic women: the st. 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