Patient-directed intelligent and interactive computer medical history-gathering systems: A utility and feasibility study in the emergency department

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Abstract

Introduction

Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED).

Methods

Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer's ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements.

Results

Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5 min and 32 s ± 1 min and 21 s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90 ± 7%, and the emergency physician asked 55 ± 18%, of the important historical elements. These groups were statistically different with a p-value of <0.00001.

Conclusion

This feasibility study has shown that the computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient.

Introduction

Healthcare expenditures have topped 100 billion dollars a year in Canada [1]. Strategies for providing efficient and effective health services are imperative. Information technology (IT) can be used to promote efficient and effective care delivery [2], [3], [4], [5]. IT has become a mainstay in the healthcare industry used for anything from the provision of automated laboratory services to integrated physician schedule and billing systems.

The vision for developing the electronic patient record (EPR) was established 40 years ago [6]. The advent of an integrated EPR is thought to be essential for the future of healthcare services [7], [8], [9]. The EPR will assist in the sharing of intra- and extra-hospital patient information and help promote efficiency [2], [4], [8], [10], [11], [12]. In 1991, The Institute of Medicine put forth a directive that the EPR should be created by 2001 and at the initial patient encounter [7]. Traditional EPR systems require the physician or other experienced medical persons to enter data [13], [14], [15].

A potential resource for the development of the EPR is the patient population [16]. A number of interactive computer applications have been adapted to involve the patient at the initial encounter [17], [18], [19], [20], [21], [22], [23], [24], [25]. Most of these systems that involve the patient are simplistic (non-comprehensive), static (questionnaire-based) [19], [20], [21], require training [26], and are time-consuming to use [18], [24]. Accordingly, few, if any of these applications have been successfully incorporated into mainstream practice. We have initiated this pilot study to evaluate the utility and feasibility of a universal, expert, interactive and comprehensive computer history-taking device directed at patients in an emergency department setting.

Section snippets

Methods

Over the past 5 years, prior to the initiation of this study, two of the authors, MB and RE, have developed an interactive touch screen computer medical history-taking device that is capable of taking patient-directed histories. This computer system (Computer Medical Solutions Inc., Toronto, Ont., Canada), initially designed with differential diagnosis capabilities, was adapted to taking patient-directed histories based on chief complaint (CC) in the general medical practice/emergency medicine

Results

A total of 67 patients used the interactive computer system. The mean time to complete the computer history was 5 min and 32 s ± 1 min and 21 s. The patient response rate was 97%. The mean age was 34 ± 13 and 67% were female. Level of education demographics were as follows: 42.4% had junior high/high school level of education, 30.3% had college level education, approximately 22.8% had either an undergraduate, professional or graduate degree, and a minority of patients had only grade school education.

Discussion

It is clear that information technology (IT) has had an extraordinary impact on the provision of health services. It has been over 40 years since the vision of a comprehensive electronic patient record (EPR) system was first established [6]. Integration of the EPR has been less than successful partly because it relies heavily on physicians and other highly skilled professionals for data acquisition [13], [14], [15]. Some EPR systems have attempted to improve physician use and acceptance by

Conclusion

We believe that a fully integrated EPR will serve to provide more efficient and effective care delivery through the sharing of intra- and extra-hospital information, the promotion of continuity of care, standardized data presentation, and quick data retrieval. It is just a question of who will take on the burden of data acquisition, the physicians, nurses, other allied health professionals, hired transcriptionists, or the patient themselves. A favourable solution would involve a combination of

Acknowledgements

We thank Alex Reidiboim for the technical support of this research project. Dr. Mark Benaroia and Dr. Roman Elinson own shares and are directors of Computer Medical Solutions Incorporated.

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    C/o author Dr. Kelly Zarnke should be listed on all mail correspondences. E-mail correspondence to first author is preferable.

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