[Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]

Preserving Patient Stories: Bioethical and Legal Implications Related to the Shift from Traditional to Digital Anamnesis

It is since the beginning of the so-called 'digital revolution' in the 1950s that technological tools have been developed to simplify and optimise traditional, time-consuming, and laborious anamnestic collection for many physicians. In recent years, more and more sophisticated 'automated' anamnestic collection systems have been developed, to the extent that they can actually enter daily clinical practice. This article not only provides a historical overview of the evolution of such tools, but also explores the ethical and medico-legal implications of the transition from traditional to digital anamnesis, including the protection of data confidentiality, the preservation of the communicative effectiveness of the doctor-patient dialogue and the safety of care in patients with poor digital and health literacy.

Evaluating an app for digital medical history taking in urgent care practices: study protocol of the cluster-randomized interventional trial 'DASI'

BACKGROUND

In out-of-hours urgent care practices in Germany, physicians of different specialties care for a large number of patients, most of all unknown to them, resulting in a high workload and challenging diagnostic decision-making. As there is no common patient file, physicians have no information about patients' previous conditions or received treatments. In this setting, a digital tool for medical history taking could improve the quality of medical care. This study aims to implement and evaluate a software application (app) that takes a structured symptom-oriented medical history from patients in urgent care settings.

METHODS

We conduct a time-cluster-randomized trial in two out-of-hours urgent care practices in Germany for 12 consecutive months. Each week during the study defines a cluster. We will compare participants with (intervention group) and without app use (control group) prior to consultation and provision of the self-reported information for the physician. We expect the app to improve diagnostic accuracy (primary outcome), reduce physicians' perceived diagnostic uncertainty, and increase patients' satisfaction and the satisfaction with communication of both physician and patient (secondary outcomes).

DISCUSSION

While similar tools have only been subject to small-scale pilot studies surveying feasibility and usability, the present study uses a rigorous study design to measure outcomes that are directly associated with the quality of delivered care.

TRIAL REGISTRATION

The study was registered at the German Clinical Trials Register (No. DRKS00026659 registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.

Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review

Background

Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians’ ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician.

Objective

Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care.

Methods

We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators.

Results

We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care.

Conclusions

The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.

Obtaining patients' medical history using a digital device prior to consultation in primary care: study protocol for a usability and validity study

Background

With the help of digital tools patients’ medical histories can be collected quickly and transferred into their electronic medical records. This information can facilitate treatment planning, reduce documentation work, and improve care. However, it is still unclear whether the information collected from patients in this way is reliable. In this study, we assess the accuracy of the information collected by patients using an app for medical history taking by comparing it with the information collected in a face-to-face medical interview. We also study the app’s usability from the patients’ point of view and analysing usage data.

Methods

We developed a software application (app) for symptom-oriented medical history taking specialized for general practice. Medical history taking will take place involving patients with acute somatic or psychological complaints (1) using the app and (2) verbally with trained study staff. To assess the perceived usability, patients will complete a questionnaire for the System Usability Scale. We will collect sociodemographic data, information about media use and health literacy, and app usage data.

Discussion

Digital tools offer the opportunity to improve patient care. However, it is not self-evident that the medical history taken by digital tools corresponds to the medical history that would be taken in an interview. If simply due to a design flaw patients answer questions about signs and symptoms that indicate possible serious underlying conditions ‘wrong’, this could have severe consequences. By additionally assessing the app’s usability as perceived by a diverse group of patients, potential weaknesses in content, design and navigation can be identified and subsequently improved. This is essential in order to ensure that the app meets the need of different groups of patients.

Trial registration German Clinical Trials Register DRKS00026659, registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.

Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study

BACKGROUND

Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED).

OBJECTIVE

We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning-based techniques to gather relevant symptoms and history for handover to clinicians.

METHODS

A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool's performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion.

RESULTS

Respondents strongly endorsed the tool for facilitating conversation (61/81, 75% of patients, 57/78, 73% of physician ratings, and 10/10, 100% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool's questions. The tool was recommended by most patients (63/81, 78%), in 53% (41/77) of physician ratings, and in 76% (61/80) of nurse ratings. Questionnaire completion rates were 100% (81/81) by patients and 96% (78/81 enrolled patients) by physicians.

CONCLUSIONS

This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient-health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00024115; https://drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115.