► High usability of mobile documentation. ► Cost-efficiency of mobile patient questionnaires. ► Pass documentation task on to patients. ► EHR-integrated patient reported outcomes data available for treatment and research.
Patient reported outcomes (PRO), such as quality of life questionnaires, are completed by patients to assess the influence of their medical condition on their lives. They are an important instrument to express the patient's voice [1] and improve the communication between physicians and patients [2]. The resulting information is not only valuable for treatment, but also for research, as Miguel et al. highly recommended for drug clinical trials recently [3]. According to the single source approach, medical data, needed for more than one purpose, should be collected only once [4], [5]. This implies to make the data electronically available. As patients usually complete the questionnaires on paper, the medical staff needs to transfer the information manually into the electronic health record (EHR). As documentation work already makes up a large amount of the available work time [6], [7], PRO questionnaires are rarely used outside those clinical studies in which they are mandatory. Both Snyder and Chang analysed this problem of “logistics” and emphasized the need of efficient methods to capture PRO data [8], [9]. To overcome these obstacles and offer an easy-to-use solution, which also makes the data available in the EHR, we developed a web-based application to enable questionnaire completion and data transfer [10]. Mobile solutions for healthcare tasks have been discussed since the early nineties [11], but are currently getting increased attention. Similar solutions focus on comprehensive questionnaire applications [12]. In our solution, however, we focused on capturing data from patients and make them available in the EHR according to the single source approach.
A previous implementation project demonstrated the feasibility of the single source approach for EHR-integrated mobile questionnaires. In this study we intended to evaluate the usability and cost-efficiency of the system to determine the conditions on which it can be used in the long run. Thus stakeholders of this study are clinical staff, medical informatics scientists and chief financial officers.
The objective of this study was to assess the web-based application for patient questionnaires as a method of collecting PRO in a single source approach. In detail we defined to evaluate:
How do patients and clinical staff rate the usability of the web-based application?
How cost-efficient is the mobile documentation workflow compared to the paper-based approach?
This study has been approved by the local ethics committee (reference number 2011-290-f-S) [13].
The Competence Centre for the Diagnosis and Treatment of Chronic Pruritus (CCP) of the University Hospital Münster [14] functioned as pilot department of the mobile patient questionnaires and for this evaluation study respectively. Approximately 2000 outpatients and inpatients are treated yearly by two physicians and four other medical and administrative staff members. The CCP is one of the leading institutes for the research of chronic pruritus on a national and international level [15], [16].
Since the objective of the study has been a comparison of usability and cost-efficiency of mobile patient questionnaires to the paper-based version, we performed a quasi-experimental field study with an observational character [22], which was conducted by a neutral evaluator to avoid a bias in the study. Regarding the staff evaluation there might be a bias as the CCP as a pilot department is open minded to health-care IT and encourages patients to use the new system. Because pre-/post studies
The participating staff members consisted of the medical head of the CCP and one further dermatologist, both taking care of the treatment of patients. Furthermore one study nurse and a non-medical scientific assistant, being responsible for the pre and post processing of the patient questionnaires, participated. All four staff members are female and have been interviewed face-to-face.
The mobile patient questionnaire user group comprised 118 patients, who were given the possibility to
In this study we wanted to assess the usability of a web-based application to capture patient questionnaires and its cost-effectiveness in consideration of the single source approach.
SUS scores and comments from the interviews show a high satisfaction with the system. Patients stated that “[…] it is much better to read and clearly arranged” and “[…] the big letters help to clearly understand the questions, especially those with negations”. Medical staff members also emphasized that “[…] the
It is worthwhile and efficient to document patient reported outcomes by using a web-based application that transfers resulting data into the EHR from where it can be used for treatment and research purposes. Good usability and cost effectiveness of the system were proven by our evaluation study and the implementation in other clinics may be recommended.
Fleur Fritz designed the system, implemented the CIS forms, guided the evaluation and wrote the manuscript. Sebastian Balhorn performed data acquisition, observations, questionnaires and interviews. Markus Riek implemented the web-based application and provided logfile data. Bernhard Breil assisted in system implementation and evaluation methods. Martin Dugas supervised the evaluation. All authors read and approved the paper.
The authors declare that they have no competing interests. Summary points What was already known on the topic: It is important to collect patient reported outcomes and thus involve the patients’ voice in the treatment. Mobile devices can be used in various clinical settings, but logistical problems for patient self-documentations still exist. A single source approach to document patient reported outcomes once and then use it for different purposes is feasible. What this study added to our knowledge:
Thanks to Prof. Dr. med. Sonja Ständer and her team of the CCP for participating in this evaluation study.
