As private homes are fast becoming critical locations for self-care and disease management, research technologies that support investigators to systematically characterize the home context are needed. Home visits can be intrusive and costly; at best, they yield text descriptions or simple images that lack precision and obscure detail. Patient self-reports rely on recall and can reflect selective perception, understating hazards or overstating space and affordances. Contemporary technologies make it possible to create full-scale 3D models of the interiors of a patient's home. Displaying these models and making them accessible through the electronic health record (EHR) could accelerate patient centered care research by supporting systematic assessment as well as enabling researchers and clinicians to detect safety barriers, recommend reconstruction, and tailor care instructions specific to the space wherein they will occur. The models could be linked with other EHR data, enabling exploration of the relationships between health states and the conditions of the homes. The purpose of this R03 proposal is to develop Home3D, a technical implementation that would allow annotated versions of these models to be used during clinical care and stored in the EHR. With proper protection, these models could be made available for research use in a manner similar to other EHR data. In concurrent work (HS22584) our team developed a process to virtualize a home by using laser technology to capture images of home interiors and display the models for research purposes on advanced visualization platforms. We and others continue to work on the data capture processes. In this proposal we will expand the research utility of this approach by making the models visible through standard browser technology and determining how to link the model to an EHR. We will create the data structures, nomenclatures and mark- up utilities. We propose a four-part process of requirements definition; technical proof of concept; stakeholder assessment; and technical and policy issues identification. With the support of our clinical partner, UW Health, we will work with Epic Systems to resolve the technical challenges and demonstrate the feasibility of linking home image data with the EHR. Through clinician and patient focus groups conducted by the UW Survey Research Center we will identify requirements. Both health professionals and patients will be involved in determining clinical value; professionals will guide us in determining when in the clinical workflow exploring and annotating a patient's home through the Home3D process adds insight and provides a platform for care planning. Patients will provide input on the feasibility, desirability and privac concerns. This is the first project to demonstrate the technical feasibility and potential research and clinical value of integrating a full-scale 3D model of a home into the clinical data. It will provide the foundation of AHRQ comparative effectiveness study of the impact on successful discharge of better representation of the home in the clinical discharge process.
This project will demonstrate the technical feasibility and clinician and patient acceptability of linking a full-scale 3D model of a private home with an electronic health record. Discharge planning instructions could be explicitly tailored to the features of a patient's home, and a record of the instructions including a marked up diagram of the home would be available. Researchers could use these images to better plan out-of-hospital care activities.
