Thailand medical mobile application for patients triage base on criteria based dispatch protocol

Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis

Objective

The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs.

Materials and Methods

A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases. Quantitative data were descriptively analyzed, and qualitative data were described and synthesized using inductive thematic analysis.

Results

Twenty-three studies were included in the analysis. The usability metrics most frequently evaluated were efficiency and usefulness, followed by user errors, satisfaction, learnability, effectiveness, and memorability. Methods used to assess usability included questionnaires in 20 (87%) studies, user trials in 17 (74%), interviews in 6 (26%), and heuristic evaluations in 3 (13%). Most CDSS inputs consisted of manual input (18, 78%) rather than automatic input (2, 9%). Most CDSS outputs comprised a recommendation (18, 78%), with a minority advising a specific treatment (6, 26%), or a score, risk level or likelihood of diagnosis (6, 26%). Interviews and heuristic evaluations identified more usability-related barriers and facilitators to adoption than did questionnaires and user testing studies.

Discussion

A wide range of metrics and methods are used to evaluate the usability of mobile CDSS in medical emergencies. Input of information into CDSS was predominantly manual, impeding usability. Studies employing both qualitative and quantitative methods to evaluate usability yielded more thorough results.

Conclusion

When planning CDSS projects, developers should consider multiple methods to comprehensively evaluate usability.

The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.

A scoping review on the use and usefulness of online symptom checkers and triage systems: How to proceed?

Background

Patients are increasingly turning to the Internet for health information. Numerous online symptom checkers and digital triage tools are currently available to the general public in an effort to meet this need, simultaneously acting as a demand management strategy to aid the overburdened health care system. The implementation of these services requires an evidence-based approach, warranting a review of the available literature on this rapidly evolving topic.

Objective

This scoping review aims to provide an overview of the current state of the art and identify research gaps through an analysis of the strengths and weaknesses of the presently available literature.

Methods

A systematic search strategy was formed and applied to six databases: Cochrane library, NICE, DARE, NIHR, Pubmed, and Web of Science. Data extraction was performed by two researchers according to a pre-established data charting methodology allowing for a thematic analysis of the results.

Results

A total of 10,250 articles were identified, and 28 publications were found eligible for inclusion. Users of these tools are often younger, female, more highly educated and technologically literate, potentially impacting digital divide and health equity. Triage algorithms remain risk-averse, which causes challenges for their accuracy. Recent evolutions in algorithms have varying degrees of success. Results on impact are highly variable, with potential effects on demand, accessibility of care, health literacy and syndromic surveillance. Both patients and healthcare providers are generally positive about the technology and seem amenable to the advice given, but there are still improvements to be made toward a more patient-centered approach. The significant heterogeneity across studies and triage systems remains the primary challenge for the field, limiting transferability of findings.

Conclusion

Current evidence included in this review is characterized by significant variability in study design and outcomes, highlighting the significant challenges for future research.An evolution toward more homogeneous methodologies, studies tailored to the intended setting, regulation and standardization of evaluations, and a patient-centered approach could benefit the field.

Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

Background

To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use.

Methods

A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology.

Results

Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use.

Conclusions

We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01689-2.

The impact of the emergency medical services (EMS) automation system on patient care process and user workflow

Background

One of the important components of the health system is the emergency medical services (EMS) system. The EMS system was implemented at Kerman University of Medical Sciences teaching hospitals to communicate the situation of patients being transferred to the hospital by EMS and to provide facilities tailored to the patient's condition. The objective of this study was to investigate the impact of the EMS system on the patient care process and the workflow of users.

Methods

The hospital information system (HIS) report was used to investigate the impact of the EMS system on the patient care process and a questionnaire was distributed among 244 participants to determine its impact on the workflow of the users. Mann–Whitney U was used to analyze HIS reports, and Chi-square was used to analyze the data collected by questionnaires.

Results

The EMS system reduced the patient's stay in hospital by an average of 3 h and 45 min. It also increased the number of patients' discharge from the emergency room to 2.2% and reduced the death rate by 1.3% (p < 0.001). Besides, 78% of physicians, 75% of nurses and 83% of technicians stated that this system has positively influenced their workflow.

Conclusions

The EMS system reduced the patient's stay in hospital and mortality, and increased the speed of patient service, readiness of users to provide patient care and the number of discharged patients. However, problems such as inappropriate technical infrastructure of the EMS system should be solved to improve patients' recovery, reduce mortality and improve user satisfaction.

Mobile Triage Applications: A Systematic Review in Literature and Play Store

The main objective of this paper is to review and analysis of the state of the art regarding triage applications (apps) for health emergencies. This research is based on a systematic review of the literature in scientific databases from 2010 to early 2021, following a prism methodology. In addition, a Google Play Store search of the triage apps found in the literature was performed for further evaluation. A total of 26 relevant papers were obtained for this study, of which 13 apps were identified. After searching for each of these apps in the Google Play Store platform, only 2 of them were obtained, and these were subsequently evaluated together with another app obtained from the link provided in the corresponding paper. In the analysis carried out, it was detected that from 2019 onwards there has been an increase in research interest in this area, since the papers obtained from this year onwards represent 38.5% of the relevant papers. This increase may be caused by the need for early selection of the most serious patients in such difficult times for the health service. According to the review carried out, an increase in mobile app research focused on Emergency Triage and a decrease in app studies for triage catastrophe have been identified. In this study it was also observed that despite the existence of many researches in this sense, only 3 apps contained in them are accessible. "TRIAGIST" does not allow the entry of an unidentified user, "Major Trauma Triage Tool" presents negative comments from users who have used it and "ESITriage" lacks updates to improve its performance.

Pharmaceutical mobile application for visually-impaired people in Thailand: development and implementation

BACKGROUND

Most mobile pharmaceutical applications produced for people with visual disabilities in Thailand fail to meet the required standard due to poor-quality regulations, defective design, lack of user support and impracticality; as a result, visually-impaired people are unable to use them. This research is motivated by the limited use of this technology in primary medical services and its aim is to enable people with disabilities to access effective digital health information. The research objective is to analyse, design and develop a mobile pharmaceutical application with functions that are appropriate for visually-impaired users, and test its usability.

RESULTS

Based on the design and development of the application, it contained five necessary functions. When testing the usability and users' satisfaction, it was found that the input or fill of information in the application was of low usability. According to the test results, the medicinal database function was missing 71 times and the voice command function was missing 34 times. Based on users' satisfaction results, users who had the highest level of usage gave higher average scores to users' attitude, users' confidence, user interface and system performance than those with lower levels of usage. The scores of both groups were found to be the same when discussing the implementation of the development.

CONCLUSIONS

This mobile application, which was developed based on the use of smart technology, will play an important role in supporting visually-impaired people in Thailand by enhancing the efficacy of self-care. The design and development of the application will ensure the suitability of many functions for visually-impaired users. However, despite the high functional capacity of the application, the gap in healthcare services between the general public and disabled groups will still exist if users have inadequate IT skills.

Patient triage system for supporting the operation of dispatch centres and rescue teams

BACKGROUND

The Thai medical application for patient triage, namely Triagist, is an mHealth application designed to support the pre-hospital process. However, since the functions of the application that are necessary for the pre-hospital process have been found not to be fully developed, the addition of a back-end system has been considered to increase its performance and usability.

OBJECTIVE

To determine the ability of the previous version to effectively manage the pre-hospital process and analyse the current problems with the pre-hospital operation. Therefore, the new system was developed to support the connection of dispatch centres or operational centres to the Triagist mobile application and system evaluation.

METHOD

Design thinking methodology was used to analyse, design and develop a patient triage system to support the pre-hospital process in Thailand based on users' requirements. 68 active members of the rescue teams and emergency medical staff in Chiang Mai and Lampang provinces were recruited to test the reliability of the system based on a prototype application.

RESULTS

The new medical mobile application for patient triage in Thailand was validated for use due to containing the two essential functions of Initial Dispatch Code (IDC) geolocation and IDC management. When the system was tested by emergency staff who were responsible for using it, those with the least experience were found to use it better than their highly experienced colleagues. Moreover, in cases where the system had been implemented, it was found to determine the frequency of symptoms, the time period during which cases occurred, and the density of cases in each area.

CONCLUSION

This system, which has been developed based on the use of smart technology, will play an important role in supporting emergency services in Thailand by enhancing the efficiency of the pre-hospital process. Emergency centres will receive IDC information from the geolocation system so that they can determine patients' location without undue delay. Emergency services will be able to rapidly prepare the necessary resources and administrative tasks will be supported by linking the dispatch centre to central rescue teams.