JMIR Publications

ABSTRACT

Background:

Collecting the medical history during a first outpatient consultation plays a crucial role in making a diagnosis. However, it is a time-consuming process while time is scarce in today’s healthcare environment. Computer Assisted History Taking (CAHT) systems allow patients to share their medical history electronically before their visit. Although multiple advantages of CAHT have been demonstrated, adoption in everyday medical practice remains low. This has been attributed to various barriers.

Objective:

To implement a CAHT-questionnaire for orthopedic patients in preparation to their first outpatient consultation.

Methods:

A multi-center retrospective cohort study was conducted in which all patients who were referred to the orthopedic department were invited to self-complete the CAHT-questionnaire. The primary outcome of the study is the completion rate to the questionnaire. Secondary outcomes included patient’s and physician’s satisfaction. These were assessed via surveys and semi-structured interviews.

Results:

In total, 5,321 patients were invited and 4,932 (92.3%) fully completed the CAHT-questionnaire. Participants (n=224) rated the easiness to complete the questionnaire with an 8.0 (0-10 scale, SD 1.9) and an 8.0 (0-10 scale, SD 1.7) on satisfaction of the consult. Satisfaction with the outpatient consultation was higher in case the given answers were used by the orthopedic surgeon during this consultation (8.3 IQR 8.0-9.1 versus 8.0 IQR 7.0-8.5, p<.001). Physician’s (n=15) scored the added value as 7.8 (0-10 scale, SD 1.7) and unanimously recognized increased efficiency, better patient engagement and medical record completeness. Implementing the patient’s answers into the EHR was deemed necessary.

Conclusions:

In this study, we have shown that previously recognized barriers to implementing and adapting CAHT can now be effectively overcome. We demonstrated that almost all patients completed the CAHT-questionnaire. This results in reported improvements in both the efficiency and personalization of outpatient consultations. Given the pressing need for personalized healthcare delivery in today’s time-constrained medical environment, we recommend implementing CAHT-systems in routine medical practice.