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Idea Medical history mobile app

By Abhijit Bhograj | 04 Dec, 2014

Good medical history takes time and is an art. It forms the basis of any exam and is the crux of diagnosis.

Since the majority of our population uses cell phones, a Medical History app is designed to take a good history before the patient visits the doctor. Key words, suggested questions and inputs given by clinicians formulate the correct questionnaire for specific ailments.

Patients can upload photos of lesions, photos of reports, and pre-send their history to the doctor for suggestions on tests, or changes in diet or medication to make before the visit.

Doctors can plan beforehand what needs to be done next for the patient. Patients who need to be treated immediately can be triaged beforehand, and patients who might need to be quarantined, or who have special needs, could be identified before entering the doctor's office. The app also saves time in taking the history and typing it up, and most importantly, saves time when a life has to be saved.

Keywords:
 

A/Prof. Terry HANNAN Advisor Replied at 7:02 PM, 4 Dec 2014

Abhijit, this posting is correctly focussed. "Why do we do a physical examinations? To confirm (or eliminate) what we know should exist FROM the medical history"
This posting also challenges all of us to review current medical history taking formats and to see if they are efficient (time consuming) and accurate.
I teach a format of history taking that permits the "gathering of clinical information that is accurate and clinically relevant that consumes about 2 minutes of my time". This 2 minutes provides the signposts to the other "relevant" aspects of the patient's clinical status.
So YES to patient self-recorded history and storage in their own record to be made available to whomever they believe needs that information.

Angela Condie Replied at 1:04 PM, 5 Dec 2014

Dear Terry,
I would be interested in how you get information in 2 minutes. Do you have an article that you can recommend on the subject? I find if I ask open ended questions, the patient may give a lot of extraneous information and take longer than 2 minutes. Since I am also trying to do it in a second/third language, sometimes just understanding the vocabulary extends the time required to get a good history. Also, our illiterate rural patients tend to give a diagnosis that is usually a common local erroneous belief, instead of symptoms. Thanks, Angela

A/Prof. Terry HANNAN Advisor Replied at 3:07 PM, 5 Dec 2014

Angela, I am about to do a ward round so I will formulate a synopsis later today. There is no paper but I have a draft concept for one drawn up. I hope you see the validity of the process. Chat soon. If you could send me your email address I will do it via that protocol and then you and i can decided whether we see value in posting it into this discussion. My email is

Abhijit Bhograj Replied at 10:08 AM, 7 Dec 2014

Hello Terry thanks for the Valuable input .
For any new idea to work especially in the medical field . We need to collectively work together as a community and get it out
The Next Is the collective years of experience we have in the field and what we see GHD doing is going to make a big difference .

Marwa Saleh Replied at 11:13 AM, 8 Dec 2014

great topic! I'm a family med resident, starting my research on the cross-cultural medical interview, which is very relevant esp in parts of the US where non-Hispanic physicians provide most of the care to Hispanic patients in under served settings. we do not get any professional training after med school, for something we spend the majority of our time as physicians doing--the medical interview. Any materials you recommend in developing a standard medical interview to be adapted to cross-cultural encounters?
Abhijit any work you've done on this already? I'm considering using a pre-interview questionnaire to help facilitate and expedite the clinical encounter. Terry, would love to get more info about your 2 minute interview and see if we can adapt it in our clinic for new residents esp (who struggle with the fast medical interview in the clinic context).

thanks!
marwa

Yael Braunsteni Replied at 3:03 PM, 8 Dec 2014

Dear Abhijit, this topic sounds really interesting and promising, however, I can't figure out how elder people would handle with this high-tec method, since a large amount of patients included in this age group don't feel completely comfortable using new technological devices or apps. What's more, this age group is characterised by an important amount of clinically relevant information, so what I'm trying to figure out is how this excellent idea can be efficiently applied in the elder people.
Thank you,
Yael

A/Prof. Terry HANNAN Advisor Replied at 5:24 PM, 8 Dec 2014

Marwa, I have been waiting to see if there were additional responses to this topic following Angela Condie's posting. It seems as if others are interested so give me a day or two and I will put together a short summary document on the topic.

A/Prof. Terry HANNAN Advisor Replied at 5:43 PM, 8 Dec 2014

Yael, in the interest of open discussion how do you explain that some of the highest uptake of mobile devices and the web - for health - is in the >65 year old age group?
Also in Surowiecki j. The Wisdom of Crowds. Anchor, editor. New York: Random House; 2005., there is some evidence that the "wisdom" shared by groups with similar or the same conditions are/maybe making better health care decisions than clinicians, even specialists.
We are in interesting times.

Anne-Marie Audet Replied at 4:10 PM, 10 Dec 2014

This is a great discussion topic. Jan Walker and Tom Delbanco who are innovating with Open Notes and Our Notes will be a great resource here. Here is a link to Open Notes.

http://www.myopennotes.org/

A/Prof. Terry HANNAN Advisor Replied at 6:52 PM, 10 Dec 2014

Is Opennotes available for non-USA download?

Abhijit Bhograj Replied at 1:10 AM, 12 Dec 2014

Hi Marwa , I have no knowledge of any such app in existence and I am willing to work with any one with technical know how , may be start with terry's 2 min Q and A

Abhijit Bhograj Replied at 3:49 AM, 12 Dec 2014

Yael you have raised a very valid point , we keep adding technology to our daily life but don't stop to think about the people who can't adapt to these changes . With regard to the history app ,we could use a phone in service / call centre or automated multi choice phone answering service

Marwa Saleh Replied at 11:04 AM, 12 Dec 2014

Terry, thank you will wait for your updates. my email is
I'm working on developing a semi-structured med interview for the cross-cultural clinic encounter. Using the data on the general med interview and resident/faculty input to guide this. if anyone has any recs would be great.
Abhijit, that would be a great project, if we find technical support.

Joaquin Blaya, PhD Advisor Replied at 2:39 PM, 13 Dec 2014

I also think this is a great idea, especially if this app would be able to store or communicate the information to an EMR over many idays so that the patient is able to reflect on what is happening to him/her over long periods of time. But I see a couple of hurdles for this to actually work, which I would be glad to help figure out how to surpass and hopefully others as well.
1. Why and who would pay for this? Perhaps health institutions for reducing the amount of time per visit (however, this seems unlikely)?
2. With all of the disparate health IT systems with information, how would the clinician get access to this information in a way that would allow him to use it?

Abhijit Bhograj Replied at 1:55 AM, 14 Dec 2014

Hi Joaquin
1) The funding for this could be from the users,doctors and insurance companies using the services of the app , insurance companies could fund as it could potentially skip the need to visit the doctor
Eg Patient A is on a new insulin dose and has an episode of mild hypoglycemia , the reason being delay in meal timings .. the history app identifies this as a potential reason , alerts the doctor and the patent could be advised a revised dose and diet
Patients would pay as it could save them one days sick leave
the doctor would fund it as the app helps saves his time and more importantly helps him keep in touch with his patient .

2) The Patient links his history to his doctor or the hospital that thay want , doctor once linked gets updates to his patients .

Abhijit Bhograj Replied at 4:19 AM, 14 Dec 2014

A Good Twin to the History App is The Follow up App
Most patient once started on a treatment are lost to follow up thanks to the complexity of our health system , the follow up app is an pre set questionnaire follow up , texted to the patient few days/hours after the primary visit . This is very important because most condition symptomatology are often missed during the primary consult and the new symptoms can be brought to light easily with out having to reschedule .
Classic Example chest pain it could be acid reflux, angina, or an MI . A patient with an MI can present early with generalised discomfort with no changes biochemically or EKG changes,such patients are treated with a PPI and sent home , Over Hours to a day symptoms of these patients change if not followed up can be missed altogether leading to an untoward situation and If all is ok its always good to boost the moral of a treating doctor to know that the treatment has worked and the patient is doing well

A/Prof. Terry HANNAN Advisor Replied at 4:48 AM, 14 Dec 2014

Abhijit, your inputs are INVALUABLE. Over the weekend I have been trying to assimilate many of the inputs on this topic and one area that I was focussing upon was the Follow UP (FU).
You posting tonight confirms my need to spend more time on this before I post a "reasonable" document.
So based on this statement of yours "the follow up app is an pre set questionnaire follow up , texted to the patient few days/hours after the primary visit".
Here are my perspectives on this (very quickly).
1. The patient should have their INITIAL record given to them at all levels of care.
2. The FU is an "extension" of this INITIAL record and should be added at the time, as an "integrated" module/function at each encounter and/or separation.
3. The above provides the concept of the "longitudinal record".
4. AT the time of the separation from the primary visit(s) the guidelines/questionnaires/quality measures should be provided to the patient/carer in either e-format or hard copy with mechanisms fro feedback communication.
5. AT ALL STAGES of the individuals care they should retain and carry ac 'copy' of their record.
On this topic "Over Hours to a day symptoms of these patients change if not followed up can be missed altogether leading to an untoward situation and If all is ok its always good to boost the moral of a treating doctor to know that the treatment has worked and the patient is doing well" I will send you a reference immediately after this.

Feedback thoughts are welcomed.

A/Prof. Terry HANNAN Advisor Replied at 5:05 AM, 14 Dec 2014

Abhijit, Here are two significant references. I have just had to reinstall EndNote so you are receiving the Abstracts as well.
(Callen, Georgiou et al. 2010; Callen, Westbrook et al. 2012)

Callen, J., A. Georgiou, et al. (2010). "A qualitative analysis of Emergency Department physicians' practices and perceptions in relation to test result follow-up." Stud Health Technol Inform 160(Pt 2): 1241-1245.
Follow-up of abnormal test results for discharged Emergency Department (ED) patients is a critical safety issue. This study aimed to explore ED physicians' perceptions, practices, and suggestions for improvements of test result follow-up when using an electronic provider order entry system to order all laboratory and radiology tests and view results. Interviews were conducted with seven ED physicians and one clinical information system support person. Interviews were analyzed to elicit key concepts relating to physicians' perceptions of test result follow-up and how the process could be improved. Results described the current electronic test result follow-up system with two paper-based manual back-up systems for microbiology and radiology results. The key issues for physicians were: responsibility for test follow-up; the unique ED environment and time pressures, and the role of the family physician in test result follow-up. The key suggestion for improvement was a complete integrated electronic information system with on-line result endorsement. The study highlighted the complexity of the test result follow-up process and the importance of engaging clinicians in devising solutions for improvements.

Callen, J. L., J. I. Westbrook, et al. (2012). "Failure to follow-up test results for ambulatory patients: a systematic review." J Gen Intern Med 27(10): 1334-1348.
BACKGROUND: Serious lapses in patient care result from failure to follow-up test results. OBJECTIVE: To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients. DATA SOURCES: Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010. STUDY SELECTION: Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices. DATA EXTRACTION: Four reviewers independently screened 768 articles. RESULTS: Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used. LIMITATIONS: Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries. CONCLUSIONS: Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.

Mark Ott Replied at 1:22 PM, 15 Dec 2014

Professor Hannan and Abhijit, I think you're both on to something important with the concept of preset follow-up questionnaires. I see a lot of overlap between this concept and a concept Joaquin Blaya and I started discussing over the weekend about automated at-home rounding (http://www.ghdonline.org/breakthrough-health-it/discussion/automated-at-home-...).

The common notion underlying both concepts is that some aspects of care can be automated. Assessing patients for symptom identification, treatment efficacy, or even screening for stress/depression (a reliable predictor of readmissions) can be automated. When implemented wisely, automating aspects of care will be enormously beneficial to both clinicians providing care and patients receiving care.

(By the way, I'm new to this community. I'm really enjoying following these discussions so far.)

Abhijit Bhograj Replied at 11:27 AM, 18 Dec 2014

Terry your students are a lucky bunch , by your method and timely input has only been getting me to open my mind and explore so thank you sir .
This is a start to the input so far
1.The Patient documents history which has been typed out by the patient on the mobile or recorded at a call centre
2.Patient Links history to the E.R doctor or existing treating doctor
3.The doctor analysis history schedules appointment /orders test/alters medication
4.During visit doctors adds to history and examination (history and finding updated on all devices )
5.once Labs /Imaging ordered ,Patent Outpatient code generated is linked to doctor and patient update sent realtime to doctor and patient .
6.Diagnosis made and follow up question list selected and sent to patent .
this is just the basic outline

Abhijit Bhograj Replied at 12:31 AM, 19 Dec 2014

Mark thank you for bringing this to light. You are correct about the overlap. Beautiful to see what your are doing , would be more than happy to give you any input in the hurdles being faced , what I would want from the idea is the patient should be more involved in his or her health from the history till the follow up, with the doctor being the guiding force . Yes there's a lot of grey areas but we have to make a start

Marwa Saleh Replied at 11:26 AM, 7 Jan 2015

http://engagedpatients.org/about/

On this topic, I would highly recommend using these patient forms in clinic. A great resource to promote health literacy esp with under-served patients in busy clinics with long dwell times and short face-to-face encounters.

and a happy new year to this great community

A/Prof. Terry HANNAN Advisor Replied at 11:12 PM, 2 Feb 2015

Because "history taking" is the core critical encounter phenomenon that we perform with patients (we do the physical examination to confirm the presence or absence what we already know from the history) I felt that the following publication which came in my citations notifications would be useful reading for the participants on this site.

Attached resource:

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Technology for Patient Engagement and GHDonline staff