Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review

Abstract

Background Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians’ ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician. Objective Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. Methods We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators. Results We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care. Conclusions The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.

Evaluating an app for digital medical history taking in urgent care practices: study protocol of the cluster-randomized interventional trial ‘DASI’

“…There have been several attempts to develop and implement digital tools as well as paper-based questionnaires to obtain information on health concerns from patients before their encounter. While many aim to improve quality of medical care, ease documentation and enhance work efficiency, these effects have hardly been studied [ 18 ]. The purpose of this study is to generate evidence on the effect of an app for medical history taking in urgent care practices in Germany using a rigorous study design.…”

“…Digital tools to obtain patients’ medical histories have been designed and evaluated for some specialties such as cardiology [ 13 ] or gastroenterology [ 14 , 15 ] but only few are available for general practice [ 16 , 17 ]. In a recently published scoping review on 18 digital tools designed for obtaining medical history from patients or caregivers [ 18 ], eight of the tools were not tailored to a specific patient subpopulation. While the research on these tools mainly comprise proof-of-concept and general usability, studies on patient experience and its impact on health outcomes are sparse.…”

Successful usage of a chatbot to standardize and automate history taking in Hymenoptera venom allergy

“…2,3 One approach to addressing the increasing number of patients and optimizing the use of resources is the application of chatbots, which can provide both patients and physicians with specific medical information including the patient's anamnesis. 4,5 Chatbot systems may be well-suited to collect medical information in an optimized and time-efficient manner.…”

Pre-consultation history taking systems and their impact on modern practices: Advantages and limitations

“…For instance, integration of systems takes time and effort, and there is no common and united system for reporting the information collected for medical records. Additionally, given the absence of evidence demonstrating improved health outcomes, physicians may not be inclined to adopt these technologies [51]. These factors could contribute to doctors' hesitation in fully embracing and utilizing these systems in their clinical practice, highlighting a potential barrier to widespread adoption.…”