Patients' Utilization and Perception of an Artificial Intelligence-Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study

BACKGROUND

When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies.

OBJECTIVE

We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting.

METHODS

Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment.

RESULTS

Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6%) of working-age individuals (aged 15-64) than the general population (66.0%). Participants rated Ada's ease of use highly, with most (511/522, 97.8%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1%) and agreed they would recommend it to a friend or relative (444/520, 85.3%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93%, 18-24-year olds reported helpful) than older respondents (19/32, 59%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0%), a sizable minority (63/494, 12.8%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22%) than aged 70+ (0/28, 0%).

CONCLUSIONS

In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups.

Evolving Frontier: A Review of the Role of Mobile Medical Application Prescribing

Objective: To describe the continuum of medical app prescribing. Data Sources: A review of literature was conducted using PubMed and MEDLINE. Search terms included medical app, prescribing, healthcare apps, medical phone apps, and mobile medical apps. Studies published in English from 2005 to December 2015 were included. Study Selection and Data Extraction: A total of 2264 articles were uncovered in the initial search. The publications included studies conducted in the United States and Europe within the past 10 years. Studies with a mobile app intervention were preferred. However, studies lacking a mobile app intervention were also included. No restrictions on the type of health application discussed in studies were chosen. Non-English language publications were excluded from the review. A total of 15 articles were selected based on the inclusion criteria and reviewer screening. Data Synthesis: The literature review identified that this is an area that requires further study to analyze the extent to which prescribers recommend apps for their patients. A concern over the lack of evidence in the effectiveness of the apps still remains. Prescribing mobile apps by providers to help keep track of their patients' symptoms and provide real-time advice on treatment and medication can be beneficial to control costs, reduce errors, and improve patients' experiences. Conclusion: The presence of mobile technology has enabled patients to become more engaged in the decision making regarding their health care. Additional resource allocation can be recommended to increase the quantity and quality of medical apps recommended by prescribers for their patients.