Fleur Fritz University of Münster, Institute of Medical Informatics (Thursday, 1.30, General 1) Patient questionnaires regarding patient reported outcomes are valuable information for the treating physician as well as for clinical researchers. To reuse this data, often documented on paper, it needs to be transferred into the respective databases by the medical staff. As this method is time-consuming and error-prone it is rarely done in routine medical care. Therefore, we developed a web-application to capture patient questionnaires on mobile devices. The resulting data is automatically transferred into the electronic health record and available to be used for different clinical purposes. We then evaluated the system with respect to usability and cost effectiveness compared to the paper-based workflow. We used iPads which paid off after 7 months taking into account material and personnel costs of a scientific assistant. The mobile application achieved a system usability score of 80.34 out of 100 points, thus proving a good acceptance by the users. Patients and medical staff reported in semi-structured interviews that they were highly satisfied with the system and they even preferred it compared to the paper-based workflow. Physicians now use quality of life information during treatment. This study shows that the mobile documentation of patient questionnaires is technically feasible and provides valuable data for treatment and research alike.

1. Mobile Patient Questionnaires
Implementation and Evaluation
Fleur Fritz - Oral Presentation 24th November - HINZ 2011 | Auckland
Sebastian Balhorn, Markus Riek, Bernhard Breil, Sonja Ständer, Martin Dugas

2. Mobile Patient Questionnaires
Implementation and Evaluation
INTRODUCTION
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

3. Patient Questionnaires
Use in Medical Care and Research
Patient reported outcomes are important to:
• Assess the patient’s perception of their health status, e.g. quality of life
• Realize gap between patient-based and physician-based assessment
Documented in:
• Clinical studies (sometimes)
• Routine patient care (rarely)
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

4. Patient Questionnaires
Use in Medical Care and Research
• “…logistical challenges in collecting, storing, analysing, and reporting
PROs in real-time have been a barrier to their use in practice”1
• Patient reported outcomes documented by patients
• Manual data transfer into the EHR and/or research database time-
consuming and error-prone
• Single Source Approach: Capture medical data once and reuse it for
different purposes (treatment, research, quality management, etc.)
1 Snyder C, Aaronson N. Use of patient-reported outcomes in clinical practice. www.thelancet.com, 2009.
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

5. Research Question
Is there an efficient and user-friendly method to collect patient
reported outcomes data by means of patient questionnaires which can
then be used for treatment as well as for research purposes?
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

6. Mobile Patient Questionnaires
Implementation and Evaluation
METHODS
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

7. The Web-based Application
• Hardware-independent
• Currently supported questionnaire forms: radio-buttons and visual
analogue scale
• XML file for data export
• Mapping to EHR form data elements
• According to usability standards
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

8. The Web-based Application
• Competence Center for the Diagnosis and Therapy of Chronic Pruritus
• Three different patient questionnaires (DLQI, HADS, PBI)
• Evaluation:
• More than 100 patients per month (paper-based and electronic
workflow)
• Time and cost measurements
• Patient/Staff questionnaires regarding usability (SUS) and
acceptance
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

9. Mobile Patient Questionnaires
Implementation and Evaluation
RESULTS
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

10. Workflow
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

11. Screenshot Application
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

12. Evaluation - Costs
• Personnel costs (manual data transfer) and material costs (paper,
staples, printing, energy, ) per paper sheet = 0.18 – 0.40 Euro
vs.
• Material costs for iPad and accessories
iPad paid off after 7 months compared to paper-based workflow
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

13. Evaluation - Usability
• System Usability Scale Score: 80 from 100 (return rate 94%)
• Patients: “[…] I just see advantages, even though I am not a fan of
computers. It is much better to read and clearly arranged and it was
not difficult at all.” - “ It was really fun!”
• Physicians: “[…] it has a significant influence on the treatment. For
example when I see that a patient has a high depression score I
choose a different medication, this is not possible when I use the
paper based version.” - “I would recommend it to other departments.””
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

14. Mobile Patient Questionnaires
Implementation and Evaluation
DISCUSSION
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

15. Advantages of Mobile Questionnaires
• Time saving
• Reducing transcription errors  Increased data quality
• Patient reported outcomes data integrated in the EHR is immediately
available for treatment and reusable for research
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

16. Mobile Patient Questionnaires
Implementation and Evaluation
FUTURE RESEARCH
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

17. Future Research
• Implementation in other hospitals and primary care
• More questionnaire types (e.g. catalogue selection)
• Diaries at home
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011

18. Thank you for your attention.
Fleur Fritz*, Sebastian Balhorn, Markus Riek, Bernhard Breil, Martin Dugas
*Institute of Medical Informatics
University of Münster
Albert-Schweitzer-Campus 1 / A11, 48149 Münster
http://imi.uni-muenster.de
Sonja Ständer
University of Münster, Department of Dermatology
Mobile Patient Questionnaires | Fleur Fritz | 24th November HINZ 2011