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Computer Patient Interviewing
Instant Medical History
and UK Experience
#DHOx Digital Health In Primary Care
19 April 2016...
Acklowledgements  Declarations
I have a commercial relationship with Primetime Medical
Software Inc (developers of the “In...
Why particularly relevant
Apparent significant demand / resources mismatch in GP
Government and others talking about “e-ma...
Let's look at some history
#DHOx
Anyone recognise this man?
#DHOx
Anyone recognise this man?
A Canadian Physician, one of the four
founding Professors of John Hopkins
Hospital, he is descr...
Sir William Osler (1849-1919)
“Talk to the Patient for long enough
 he will tell you what is wrong
with him”
#DHOx
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
“Toward Automating
the Medical History”
“...to relieve the physician from routine, although
important, time‑consuming acti...
Important reviews
Jones RB, Knill-Jones RP. Electronic Patient Record
Project: Direct Patient Input to the Record. Report ...
Highlights
Warner Slack paper 1960’s
Ray Jones paper 1990’s
Pringle, BMJ 1988
Prof Bachman literature review 2003
Slack WV...
Common conclusions
“A well designed computer system can be used
to interview patients about their medical history,
signs a...
From 1968
“A branching series of questions is developed to
assist the medical history taking of the clinician.
Standard, c...
Professor Ray Jones
From the number of published research studies in
which computers have been successfully used to interv...
Dr M Pringle
“Computers may be used acceptably to gather
accurate information and to improve medical
decisions without dim...
Professor John Bachman MD
“Computer Patient Interviewing is valid”
“Instant Medical History is the World leader”
Bachman J...
Can a computer take a Psychiatric History?
“A program on an inexpensive microcomputer was designed to elicit
personal hist...
Comparison of computer-based  personal interviews
“A computer-based questionnaire can generate responses that are
equivale...
Mayo Clinic eVisits 2010
“The e-visits made surgery visits unnecessary in 1012
cases (40%)”
“In the basic e-visit process,...
History taking: How do we perform?
Physicians miss 54% of patients problems and
45% of their concerns
In 50% of visits pat...
History taking: how does the
Computer Perform?
#DHOx
Strengths of Computerised interview
Structured, all questions are asked
Does not Interrupt
Good at obtaining sensitive inf...
Strengths of Computerised interview
All questions usually answered
Can be done anywhere, at Patient’s pace
 with family he...
Patient can complete as little or
as much as they feel able and the
depth of questioning can be tailored
to suit the clini...
Computers show no embarrassment
in asking important questions where
responses deem that question is
worth answering
#DHOx
Presenting Complaint
A M is a 13 year old male. His reason for visit is “Pre-Participation Sports Examination”
Past, Famil...
ENT
History of Ear surgery for infection
Accidents and Injuries
History of Concussion. Bone fracture. Post head injury con...
Patients collect info that Clinicians miss
40% of the time the questionnaire provided
useful information that would not be...
Particularly relevant
Psychological issues
Illicit Drugs
Alcohol
Documentation
Evidence strongly suggests that people will...
Completeness
CPI ensures that lines of investigation are not forgotten, leading to more
complete data and fewer errors in ...
Alcohol
Alcoholic Captain
“Wanted to be caught”
Wasn’t asked the right questions
CPI would have asked
#DHOx
Let Patients do the work
The use of Computer Patient Interviewing allows patients
to give a very full history whilst savin...
Outcomes of using CPI
More complete questioning.
Better documentation which in turn will enhance the
ability to compare re...
Change Management in Healthcare
“That the stethoscope will ever come into general use,
notwithstanding its value, is extre...
Instant Medical History: UK Experience
Implementation Partner:
Wiggly-Amps.com #DHOx
Instant Medical History: UK Experience
Proof of Concept:
http://www.htmc.co.uk/pages/pv.asp?p=htmc0473
@AmirHannan #DHOx
#DHOx
Instant Medical History: UK Experience
An implementation:
3GDoctor.com #DHOx
#DHOx
Instant Medical History: UK Experience
An implementation:
World's first Mobile Video Consulting service
Private docu...
Instant Medical History: UK Experience
An implementation:
AskMyGP .UK #DHOx
Instant Medical History: UK Experience
An implementation:
AskMyGP .UK
More than 20,000 Patients used the
service with thei...
Instant Medical History: UK Experience
An implementation:
AskMyGP .UK
If you have a GP Practice and would like to
implemen...
Patients quickly adapt to online access: At Botolph
Bridge 40% of demand moved online in 2 weeks.
Demand follows predictable daily pattern, high
Mondays, low weekends
Patients are interacting with the service in working
hours  spread is better than with Telephone rush
All Ages are accessing online (from 0-102 years).
60/40 Female/Male split is usual for GP Demand.
73% of Patients want help from anyone,
27% request named GP  10% want most popular GP.
5,000 symptoms entered resolve into 320 different
groups (and counting)
Top 10, Family Practice, Peterborough
Children under 5, North London
Adults aged 20-60, Deprived Area, Scotland
87% presented with single problem.
13% presented with more than one problem.
50% of demand is a new problem,
21% is follow up  29% an existing condition.
Duration: Most sessions take between 2  12 mins,
Median is 6 mins, all in Patients own time.
Patient Feedback: 57% say new system is better,
37% same and only 8% say worse.
Past month: 60% say new service is better, including
63% aged 60+ and 64% used service more than once.
Comments: over 1000 comments posted online
Like the convenience, and 4/5 recommend
Quicker than phone
Late in the evening
...
Comments: examples
This seems like a good
way not having to explain
your private symptoms to
the receptionist.
This seems ...
We have learned...
Patients are adopting fast
– Simple interface which works on any device
– Need freedom to ask any quest...
How AskMyGP works as a system
Thank you for your interest
Dr Richard Sills
rosills1@gmail.com
+44 (0) 7940836337
https://www.youtube.com/watch?v=uY32p_BqPw0
“Yes, yes, Mrs Jones... ...we'll talk about your chest pain in one
minute. Right now I'm just trying to remember my passwo...
A machine cannot come between
me and my Patient!
All of this is true
It need not happen
A case (thanks to Prof Bachman)
A patient who has hypertension comes to see you
because in the last ten days she has noted...
Chief Complaint
Time/Date
Sonk is a 65 year old female. Her reason for visit is “Hypertension” 13:34pm. April 17, 2003
His...
WHAT A DOC!!!!!
1) Her B/P is coming down: 138/80 and now 128/78
2) Her “numb feet” have responded well to the iron
supple...
What can we learn from this?
We can not judge quality of care by reviewing
a chart!
Inputs are important
Computerised hist...
CPI allows patients to more easily disclose information
about embarrassing topics eg. computer interviewing for
pelvic flo...
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Computer Patient Interviewing: Instant Medical History & UK Experience

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Draft of slides used by Dr Richard Sills at Digital Health Oxford's Digital Health in Primary Care meeting held at the Oxford Launchpad, Said Business School, on the 19th April 2016:

http://www.meetup.com/Digital-Health-Oxford/events/230141103/

"How can we make it easier for patients to access primary care and GPs, and what are the opportunities for improving the value of the care provided? What are the best ways to leverage new technologies to answer these challenges? How are the disparate problems of patient engagement, interoperability and scaling approached? Please join us for an evening of talks and discussion on the evening of Monday 18th April at the Launchpad"

Other speakers included:

Helen Atherton, University of Warwick & University of Oxford.

Steve Lillywhite, Technical Director, webGP (the telehealth arm of the Hurley Group).

Matteo Berlucchi, CEO, your.MD.

Harry Longman, CEO, GP Access

NB If you would like Dr Sills to give this talk at your organisation please email rosills@gmail.com

Published in: Health & Medicine
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Computer Patient Interviewing: Instant Medical History & UK Experience

  1. 1. Computer Patient Interviewing Instant Medical History and UK Experience #DHOx Digital Health In Primary Care 19 April 2016 Dr Richard Sills rosills1@gmail.com
  2. 2. Acklowledgements Declarations I have a commercial relationship with Primetime Medical Software Inc (developers of the “Instant Medical History” CPI system) Prof Ray Jones, Health Informatics, University of Plymouth John Bachman MD, Professor of Primary Care, Mayo Clinic Harry Longman, GPAccess Jon Witte, Wiggly-Amps #DHOx
  3. 3. Why particularly relevant Apparent significant demand / resources mismatch in GP Government and others talking about “e-mailing patients and e-consultations” Other industries have harnessed the “on-line experience” Patients, doctors and GP staff - frustrated #DHOx
  4. 4. Let's look at some history #DHOx
  5. 5. Anyone recognise this man? #DHOx
  6. 6. Anyone recognise this man? A Canadian Physician, one of the four founding Professors of John Hopkins Hospital, he is described as the Father of Modern Medicine. #DHOx
  7. 7. Sir William Osler (1849-1919) “Talk to the Patient for long enough he will tell you what is wrong with him” #DHOx
  8. 8. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” . by Mayne, Weksel, and Sholz #DHOx
  9. 9. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 2007? #DHOx
  10. 10. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 2004? #DHOx
  11. 11. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 1996? #DHOx
  12. 12. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 1989? #DHOx
  13. 13. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 1988? #DHOx
  14. 14. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? 1979? #DHOx
  15. 15. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz When was this published? Before 1969? #DHOx
  16. 16. “Toward Automating the Medical History” “...to relieve the physician from routine, although important, time‑consuming activities, thereby extending his capabilities to provide medical care. If the time physicians spend in collecting, organizing, recording, and retrieving data could be reduced, at least in part, by information technology, more time would be available for actual delivery of medical care and at the same time the physician’s capabilities for collecting information from patients would be extended...” by Mayne, Weksel, and Sholz (1968) #DHOx
  17. 17. Important reviews Jones RB, Knill-Jones RP. Electronic Patient Record Project: Direct Patient Input to the Record. Report for the Strategy Division of the Information Management Group of the NHS Management Executive: University of Glasgow, 1994. (Updated 1997). Bachman JW. The patient-computer interview: A neglected tool that can aid the clinician. Mayo Clinic Proceedings 2003;78(1):67-78. Slack WV. Cybermedicine for the patient. American Journal of Preventive Medicine 2007;32(5):S135-S136. #DHOx
  18. 18. Highlights Warner Slack paper 1960’s Ray Jones paper 1990’s Pringle, BMJ 1988 Prof Bachman literature review 2003 Slack WV. Cybermedicine for the patient. Prof Bachman “evisits” 2010 #DHOx
  19. 19. Common conclusions “A well designed computer system can be used to interview patients about their medical history, signs and symptoms” “Such systems are acceptable to the majority of patients” “Systems give patients more time to think about questions” #DHOx
  20. 20. From 1968 “A branching series of questions is developed to assist the medical history taking of the clinician. Standard, carefully worded questions are used to collect a history, with systems having hundreds if not thousands of questions, but patients only answering those relevant” #DHOx
  21. 21. Professor Ray Jones From the number of published research studies in which computers have been successfully used to interview patients, I think there is no need to spend time discussing the following: A well designed computer system can be used to interview patients about their medical history, signs and symptoms. Such systems are acceptable to the majority of patients @rjonesplymouth #DHOx
  22. 22. Dr M Pringle “Computers may be used acceptably to gather accurate information and to improve medical decisions without diminishing the role of the doctor” Using computers to take patient histories, M Pringle, Nottingham University Medical School, BMJ volume 297, Sept 1988 #DHOx
  23. 23. Professor John Bachman MD “Computer Patient Interviewing is valid” “Instant Medical History is the World leader” Bachman JW. The patient-computer interview: A neglected tool that can aid the clinician. Mayo Clinic Proceedings 2003;78(1): 67-78. #DHOx
  24. 24. Can a computer take a Psychiatric History? “A program on an inexpensive microcomputer was designed to elicit personal histories from patients in a general psychiatric ward. Their answers were compared with the information recorded by the responsible psychiatric team. Where answers disagreed with the clinicians' records, the patient was interviewed to investigate the discrepancy” “Most patients' computer histories revealed several items unknown to the clinicians and of importance in the management of the patient. Most patients (88%) found that the computer interrogation was as easy as a clinical interview” “Computer assessment is proposed as a useful technique for the routine assessment of patients to augment the clinician's findings and to allow her to concentrate on the most relevant areas” Carr AC. Ghosh A. Ancill RJ. Can a computer take a psychiatric history? Psychological Medicine. 13(1):151-8, 1983 Feb. #DHOx
  25. 25. Comparison of computer-based personal interviews “A computer-based questionnaire can generate responses that are equivalent to the responses to a traditional personal interview. In some cases, a computer may be more successful in eliciting risk factors” Hasley S A comparison of computer-based and personal interviews for the gynecologic history update. Obstetrics Gynecology. 85(4):494-8, 1995 Apr. #DHOx
  26. 26. Mayo Clinic eVisits 2010 “The e-visits made surgery visits unnecessary in 1012 cases (40%)” “In the basic e-visit process, patients entered their reported problem in free text (eg, “back pain”) and then answered questions one at a time. The questions branched such that the history was organised into a readable clinical format” Pilot Study of Providing Online Care in a Primary Care Setting Steven C. Adamson, MD, and John W. Bachman, MD. Mayo Clinic Proceedings August 2010 vol. 85 no. 8704-710 #DHOx
  27. 27. History taking: How do we perform? Physicians miss 54% of patients problems and 45% of their concerns In 50% of visits patients and doctors do not agree on the presenting problem 50% of psychological problems are missed Only 23 seconds before patient is interrupted (12 secs for medical residents) Biggest complaint in patient “satisfaction” is poor physician communication skills. (See Bachman Literature review for references) #DHOx
  28. 28. History taking: how does the Computer Perform? #DHOx
  29. 29. Strengths of Computerised interview Structured, all questions are asked Does not Interrupt Good at obtaining sensitive information Patients better prepared for a subsequent face to face consultation Legible summaries and direct input to Electronic Record Scales calculated well Effective at improving care quality #DHOx
  30. 30. Strengths of Computerised interview All questions usually answered Can be done anywhere, at Patient’s pace with family help Different languages Better data- better research Checklist Does not require Clinician’s time Acceptable to Patients in multiple studies #DHOx
  31. 31. Patient can complete as little or as much as they feel able and the depth of questioning can be tailored to suit the clinical setting #DHOx
  32. 32. Computers show no embarrassment in asking important questions where responses deem that question is worth answering #DHOx
  33. 33. Presenting Complaint A M is a 13 year old male. His reason for visit is “Pre-Participation Sports Examination” Past, Family, and Social History Accidents and injuries History of: Concussion. Injuries: torn ligaments. Head injury. Broken leg Head laceration. Family History Mother History of: Asthma Social History History of: Physical assault less than 2 months ago and by unknown person Allergy History History of: No allergies to medicines, pollen, foods or stinging insects PreviousTests History of: Previous investigation included an X-Ray of the shoulder. Doesn't know number of leg X-Rays. Doesn't know number of arm X-Rays. Review of Systems Eye He reported: Recent vision changes Neurologic He reported: Pins and needles after injury.. Paralysis after injury. Headaches sometimes precipitated or aggravated by exertion. Risk Factors, Prevention, and Patient Issues Prevention He reported: Not wearing protective eyewear and sometimes not wearing a seat belt in a car. #DHOx
  34. 34. ENT History of Ear surgery for infection Accidents and Injuries History of Concussion. Bone fracture. Post head injury confusion and fatigue. Memory loss a few seconds before injury. Injury from ligaments. Head injury. Loss of consciousness Immediately at time of injury, a few seconds after injury, and for an undetermined time period. Torn ligament of the right foot. Rib sprains. Neck sprain. Sprained middle back. Doesn't know Number of leg sprains. One leg torn ligament. Head laceration. Family History History of Heart disease (immediate family), Asthma (distant family). Sister History of Asthma Social History History of Thinking someone in family has a substance abuse problem Activities for Daily Living History of Sports participation restricted for health reasons Substance Use Tobacco Use History of Friend or family use tobacco Alcohol History of Alcohol intake Drug Usage History of Friends bring alcohol to School Medication History Ongoing Medications History of Prescription medication for more than 3 months. Medication stopped in the last month and dosage change. Prescribed medication very effective. Medications prescribed by another physician. Most of the time compliant with Prescription. Inhaler use. Over-the-counter Medications History of Non-prescription medication Complementary Medicines History of Nutritional supplements in last month and for weight gain Adverse Drug Reactions #DHOx
  35. 35. Patients collect info that Clinicians miss 40% of the time the questionnaire provided useful information that would not be typically elicited Essential Questions aren't missed Pilot’s Checklist #DHOx
  36. 36. Particularly relevant Psychological issues Illicit Drugs Alcohol Documentation Evidence strongly suggests that people will be more honest with the CPI than face to face. #DHOx
  37. 37. Completeness CPI ensures that lines of investigation are not forgotten, leading to more complete data and fewer errors in diagnosis and better agreement between Patient and Doctor. For example, a recent German hospital study found that computer histories reported an additional average of 3.5 problems per patient which were not recorded in corresponding physician histories. The authors recommended a combination of computer and physician histories as the best method. Zakim D, Braun N, Fritz P, Alscher MD. Underutilization of information and knowledge in everyday medical practice: Evaluation of a computer-based solution. BMC Medical Informatics and Decision Making 2008;8:12. #DHOx
  38. 38. Alcohol Alcoholic Captain “Wanted to be caught” Wasn’t asked the right questions CPI would have asked #DHOx
  39. 39. Let Patients do the work The use of Computer Patient Interviewing allows patients to give a very full history whilst saving the clinicians time. This will capture sensitive information at least as well as a face to face questions and probably more reliably. Many more direct questions can be asked. Standard Instruments can be administered and scored as a routine (PHQ-9, GAD-7 etc) #DHOx
  40. 40. Outcomes of using CPI More complete questioning. Better documentation which in turn will enhance the ability to compare responses over time. Much better coded symptom data. Standard Instruments scored. Improved assessment and particularly Psychological / sensitive issues. Increased efficiency #DHOx
  41. 41. Change Management in Healthcare “That the stethoscope will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner because it's hue and character are foreign and opposed to all our habits and associations” The Times 1834 #DHOx
  42. 42. Instant Medical History: UK Experience Implementation Partner: Wiggly-Amps.com #DHOx
  43. 43. Instant Medical History: UK Experience Proof of Concept: http://www.htmc.co.uk/pages/pv.asp?p=htmc0473 @AmirHannan #DHOx
  44. 44. #DHOx Instant Medical History: UK Experience An implementation: 3GDoctor.com #DHOx
  45. 45. #DHOx Instant Medical History: UK Experience An implementation: World's first Mobile Video Consulting service Private documented Consults available 24x7 (UK Ireland only) Launched November 2006 Best Practice in Video Consulting (Doctors 2.0 Paris): https://www.youtube.com/watch?v=z4JoJnRbsbI #DHOx
  46. 46. Instant Medical History: UK Experience An implementation: AskMyGP .UK #DHOx
  47. 47. Instant Medical History: UK Experience An implementation: AskMyGP .UK More than 20,000 Patients used the service with their GP in the first 5 weeks
  48. 48. Instant Medical History: UK Experience An implementation: AskMyGP .UK If you have a GP Practice and would like to implement AskMyGP contact Harry@GPAccess.uk
  49. 49. Patients quickly adapt to online access: At Botolph Bridge 40% of demand moved online in 2 weeks.
  50. 50. Demand follows predictable daily pattern, high Mondays, low weekends
  51. 51. Patients are interacting with the service in working hours spread is better than with Telephone rush
  52. 52. All Ages are accessing online (from 0-102 years). 60/40 Female/Male split is usual for GP Demand.
  53. 53. 73% of Patients want help from anyone, 27% request named GP 10% want most popular GP.
  54. 54. 5,000 symptoms entered resolve into 320 different groups (and counting)
  55. 55. Top 10, Family Practice, Peterborough
  56. 56. Children under 5, North London
  57. 57. Adults aged 20-60, Deprived Area, Scotland
  58. 58. 87% presented with single problem. 13% presented with more than one problem.
  59. 59. 50% of demand is a new problem, 21% is follow up 29% an existing condition.
  60. 60. Duration: Most sessions take between 2 12 mins, Median is 6 mins, all in Patients own time.
  61. 61. Patient Feedback: 57% say new system is better, 37% same and only 8% say worse.
  62. 62. Past month: 60% say new service is better, including 63% aged 60+ and 64% used service more than once.
  63. 63. Comments: over 1000 comments posted online Like the convenience, and 4/5 recommend Quicker than phone Late in the evening GP or message suggested new service Some appreciate the questions Thorough, questions good allowed me to express concerns Like not having to explain to a receptionist Some feel it’s too much Too many questions Some not relevant
  64. 64. Comments: examples This seems like a good way not having to explain your private symptoms to the receptionist. This seems like a good way not having to explain your private symptoms to the receptionist. I like this; I don't have a lot of time to wait on the phone so would prefer to deal online. I can see myself using this all the time now. I like this; I don't have a lot of time to wait on the phone so would prefer to deal online. I can see myself using this all the time now. been excellent so far! been excellent so far! I used this system because of the delay in a telephone call to the surgery taking a long time to answer. I used this system because of the delay in a telephone call to the surgery taking a long time to answer. I felt as if it asked a lot of questions, some didn't appear to me as a lay person to be relevant I felt as if it asked a lot of questions, some didn't appear to me as a lay person to be relevantUsed because of difficulty contacting practice while I am at work. It is not always convenient to discuss personal issues. Used because of difficulty contacting practice while I am at work. It is not always convenient to discuss personal issues.
  65. 65. We have learned... Patients are adopting fast – Simple interface which works on any device – Need freedom to ask any question, 2/3 are medical, 1/3 other – Rapid response is crucial – 23 minute average to date – Consistent message from practice staff, phone messages SMS All ages are using it – 0 – 102 year old patients – 14 % are parents and 4% carers – Analyse symptoms by age groups, location Demand is closely matched to opening hours – Very low at weekends – High Mondays, tails off through the week – Mornings twice the level of afternoons –
  66. 66. How AskMyGP works as a system
  67. 67. Thank you for your interest Dr Richard Sills rosills1@gmail.com +44 (0) 7940836337
  68. 68. https://www.youtube.com/watch?v=uY32p_BqPw0
  69. 69. “Yes, yes, Mrs Jones... ...we'll talk about your chest pain in one minute. Right now I'm just trying to remember my password”
  70. 70. A machine cannot come between me and my Patient! All of this is true It need not happen
  71. 71. A case (thanks to Prof Bachman) A patient who has hypertension comes to see you because in the last ten days she has noted that her blood pressure is elevated from its baseline. Meds Lisinopril 20 mg daily BP 152/93
  72. 72. Chief Complaint Time/Date Sonk is a 65 year old female. Her reason for visit is “Hypertension” 13:34pm. April 17, 2003 History of Present Illness SOnk reported: palpitations. Irregular, missed, or skipped heart beats. SOnk denied: angina pectoris. Pressure or pain in chest. Pale or white episodes sometimes. Past, Family and Social History Past Medical History History of: last blood pressure high. Hypertension within five to ten years. Hypercholesterolemia. Hypertriglyceridemia. Family History History of family members with high blood pressure. Social History Alcohol History of: alcohol use weekly Medication History Ongoing Medications History of: female hormoe medication. Conjugated estrogens. Non-prescription non-steroidal anti- inflammatory medication for pain. Past Medications History of: estrogen replacement hormones. Estorgen and progesterone combination replacement hormones. Estrogen progresterone combination therapy 11 to 15 years. Estrogen replacement therapy 11 to 15 years. Oral contraceptives. Review of Systems Constitutional Respiratory SOnk denied: Overweight SOnk denied: dyspnea. Genitourinary Skin SOnk denied: dyspnea. SOnk denied: acne Musculoskeletal Psychiatric SOnk denied: legs painful. SOnk denied: recent stress Neurological Skin SOnk denied: headaches. Tremulousness. SOnk reported: Paresis Risk Factors Physical Conditioning Nutrition SOnk reported: 30 min per day exercise SOnk reported: Eating imported licorice
  73. 73. WHAT A DOC!!!!! 1) Her B/P is coming down: 138/80 and now 128/78 2) Her “numb feet” have responded well to the iron supplements. She is glad. 3) She has stopped her licorice and excess salt intake 4) She thanks you for sending her to the Patient Education class on Hypertension and YES you were right – she did learn something! This IS the truth and nothing but the truth.... A case (thanks to Prof Bachman)
  74. 74. What can we learn from this? We can not judge quality of care by reviewing a chart! Inputs are important Computerised history provided more information that was critical to this case, and was valuable to the clinician
  75. 75. CPI allows patients to more easily disclose information about embarrassing topics eg. computer interviewing for pelvic floor symptoms in both primary care and hospital found ‘Despite the taboo nature of many of the items, the questionnaire was well received by women in both settings’ Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ. Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG 2006;113(2):231-238. Embarrassing Topics

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