A Wireless Health Outcomes Monitoring System (WHOMS): development and field testing with cancer patients using mobile phones

Abstract

BackgroundHealth-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering printed questionnaires have limited their use. Telehealth technology could reduce these barriers and encourage better doctor-patient interaction regarding patient symptoms and quality-of-life monitoring. The aim of this study was to develop a new system for transmitting patients' self-reported outcomes using mobile phones or the internet, and to test whether patients can and will use the system via a mobile phone.MethodsWe have developed a prototype of a Wireless Health Outcomes Monitoring System, which allows structured questionnaires to be sent to the patient by their medical management team. The patients' answers are directly sent to an authorised website immediately accessible by the medical team, and are displayed in a graphic format that highlights the patient's state of health. In the present study, 97 cancer inpatients were asked to complete a ten-item questionnaire. The questionnaire was delivered by display on a mobile phone, and was answered by the patients using the mobile phone keypad.ResultsOf the 97 patients, 56 (58%) attempted the questionnaire, and all of these 56 completed it. Only 6% of the total number of questions were left unanswered by patients. Forty-one (42%) patients refused to participate, mostly due to their lack of familiarity with mobile phone use. Compared with those who completed the questionnaire, patients who refused to participate were older, had fewer years of education and were less familiar with new communications technology (mobile phone calls, mobile phone SMS, internet, email).ConclusionMore than half of the patients self-completed the questionnaire using the mobile phone. This proportion may increase with the use of multichannel communications which can be incorporated into the system. The proportion may also increase if the patient's partner and/or family were able to assist the patient with using the technology. These preliminary results encourage further studies to identify specific diseases or circumstances where this system could be useful in patients' distance monitoring. Such a system is likely to detect patient suffering earlier, and to activate a well-timed intervention.

Mobile phone technology in chronic disease management

“…The proportion of users might also increase in practice as patients who are not familiar with use of the technology may be able to access help from family or friends to transfer data. The study highlights some issues with acceptability of technology, particularly for older individuals who may be less familiar with mobile phones in everyday life (Bielli et al 2004). However, data suggest that older adults are more likely to use mobile phones than the internet (ONS 2007), and, as technology infiltrates more aspects of daily living, generational differences in use are likely to decline.…”

“…This has implications for health education. Bielli et al (2004) suggest that using mobile technology might be feasible for accessing cancer patients in the community. The proportion of users might also increase in practice as patients who are not familiar with use of the technology may be able to access help from family or friends to transfer data.…”

“…However, the technology is highly topical and the literature reports rapid advancement in the field, for example in the management of cancer (Bielli et al 2004, Maguire et al 2008, asthma (Anhøj and Møldrup 2004), diabetes (Giménez-Pérez et al 2002, Farmer et al 2005, Gammon et al 2005, Carroll et al 2007, Kim and Jeong 2007, and the care of older people (Miskelly 2005). A review identified that studies have been conducted predominantly in Europe (Italy, Denmark, Norway, Spain and the UK), Korea and the United States (US) (Blake 2008b).…”

“…This information was then accessed by the medical team and provided graphical representation of the patient's health status. Bielli et al (2004) tested the WHOMS with 97 cancer inpatients and found that more than half successfully completed a health-related quality of life questionnaire with minimal missing data. However, 42% of the patients refused to use the system, which suggests that compliance could be an issue, particularly for those individuals who may be less familiar with the technology.…”

“…In Italy Bielli et al (2004) developed a wireless health outcomes monitoring system (WHOMS) to improve communication between medical teams and patients about symptoms and quality of life. The WHOMS system allowed structured questionnaires to be sent directly to a patient's mobile phone by the medical team.…”