Table 2.

Core activities of both humans and computer applications in the PGHD workflow.¹⁰

Workflow activity	Definition	Actors involved	Remote BP monitoring for hypertension	Example measures
Identify	EHR identifies patients eligible for specific PGHD (Human or CDS logic)	EHR to Healthcare provider	Identify patients at risk for hypertension who might benefit from monitoring.	Number of patients identified Percentage of patients identified who clinician invited
Order	Clinician orders PGHD data collection for specific patients13	Healthcare provider to Dashboard	Patient receives an invitation to enroll in a BP monitoring program.	Number of patients receiving invitations to enroll Demographic breakdown of patients invited (eg, age, gender, ethnicity, SDOH)
Educate	Educate patient on how to use device safely and correctly	Healthcare provider to Patient/Caregiver	Care manager instructs patient on proper use of the device.	Number of patients educated Percentage of patients with device who got educated Patient satisfaction with education
Enroll	Request for patient to enroll in data collection program	Healthcare provider to Patient App/Portal	Clinician recommends home BP monitoring.	Number of patients sent request Measure of equitability in requests sent
Consent	Patient agrees to participate in data collection program	Patient/Caregiver to PGHD Device and Dashboard	Patient agrees to share BP data.	Number of patients who successfully consented to be in study Time between getting invitation and consenting to study
Connect	Patient connects device to App/Portal	PGHD Device to Dashboard	Patient enables data sharing between device and App/Portal	Number of patients who successfully connected device
Admin Display	Display activities related to PGHD collection	Dashboard	Activities displayed on dashboard.	% of clinicians responsible for a patient who review dashboard; % of patients reporting PGHD who review dashboard
Collect/Send	Patient uses device to collect and send physiologic data to the Patient App which sends it to their EHR	PGHD Device to Patient App/Portal	Patient begins collecting BP data. BP data are sent to clinician.	Number of patients who report collecting data Number of patients sending data Number of times each patient sent data Length of time between first and last submission of data
Receive and Store	Receive data from patient and store in the app and EHR	Patient App/Portal to EHR	Clinician receives data from patient.	Number of patients from whom data was received Number of times data was received Amount of data received in mb
Notify	Notify clinician/care team and patients of potentially dangerous findings and potential action steps	EHR to Healthcare provider	Clinician/patient notified re: abnormal findings.	Number of clinicians notified Percentage of patients sending data that generated a notification
Summarize	Analyze and summarize patient data	EHR to Dashboard	BP values and trends are summarized and checked for potentially life-threatening abnormalities or changes.	Mean time required to analyze/summarize data
PGHD Display	Display patient data for patients and clinician	Dashboard to Healthcare provider	Patient data displayed on dashboard.	User perceptions of display quality, accuracy, usefulness, etc.
Review and Respond	Review patient data	Healthcare provider to Patient App/Portal and Patient/Caregiver	Patient and provider review patient data.	Percentage of patients with data that were reviewed within x days
Deliver	Deliver normal and abnormal findings to patient	Patient App/Portal to Patient/Caregiver	Clinicians call, text, or email patients (depending on severity of symptoms) with instructions on how to manage BP changes (eg, increase dose of medication or come to the ED).	Number of messages sent Mean time between receipt and reading of message Mean time to respond to emergency notification
Manage	Patient reviews data and plans changes Rx or visits provider	Patient/Caregiver to Dashboard	At some point, the clinician needs to manage the patient’s condition via changes to medications, or lifestyle counselling, for example.	Percentage of patients contacted at least 1 time in first x months Mean number of times patients were contacted in x months Type of management actions taken
Document	Store raw data values, summaries, and follow up actions in patient’s EHR or external DB linked to patient ID	Healthcare provider to EHR	A summary of the patient’s BP readings and clinician instructions for changes in medication management are stored in the EHR.	Number of patients managed in time period Number of changes in therapy made Number of patient visits
Follow-up	Follow-up periodically or after completion of time- or condition-limited monitoring	Patient/Caregiver to EHR	Healthcare organization tracks clinical and patient-centered outcomes.	Use appropriate patient-reported measures of monitoring target Assess satisfaction with monitoring system

Abbreviations: BP = blood pressure; CDS = clinical decision support; DB = data base; ED = emergency department; EHR = electronic health record; mb = megabytes; PGHD = patient-generated health data.