User experience with a voice-enabled smartphone app to collect patient-reported outcomes in rheumatoid arthritis.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic disease, requiring frequent patient-provider interaction and self-monitoring. We developed a novel mobile health smartphone app with a voice-enabled feature to help patients virtually track disease activity and ask general questions about RA. METHODS: With a user-centered design (UCD) approach, we developed a voice-enabled app (VEA) which was then tested in two focus groups of patients (n=8) and one with providers (n=4). Voice enablement and a question and answer (Q & A) library function were previously requested by patients. Based on focus group feedback, the VEA was refined and tested with 26 patients for 56 days. The VEA asked patients to fill in daily patient-reported outcomes (PROs) and complete the trial with a satisfaction survey. RESULTS: Of the 26 patients in the VEA trial, 77% were female and 50% were aged 55 and older. Adherence to daily PROs during the 56-day trial was 66%, with <1% of PROs completed using the voice-enabled feature. PROMIS short forms and RADAI-5 PROs remained stable. Of the 22 satisfaction survey respondents, 86% were satisfied with their overall experience with the app and 18.5% were satisfied with voice enablement. The voice assistant had an 86% success rate at understanding and answering interactions regarding surveys and a 44% success rate regarding Q & A interactions. CONCLUSIONS: We developed a novel VEA through a UCD framework and conducted pilot testing. Adherence was moderate and RADAI-5 and PROMIS measures were stable. Based on satisfaction results, PROs may not be the best use of voice enablement technology.

Mobile Apps for Individuals With Rheumatoid Arthritis: A Systematic Review.

BACKGROUND: Mobile health applications (apps) have the potential to help individuals with chronic illnesses learn about, monitor, and manage their condition, but these apps are largely unexamined, with the state and direction of development unclear. OBJECTIVE: We performed a systematic review of publicly available apps, directed toward individuals with rheumatoid arthritis (RA); described their current features; and determined areas of unmet need. METHODS: We searched the iTunes and Google Play App Stores for the term "arthritis" and reviewed the descriptions of these apps for specific mentions of RA. Applications that met inclusion criteria were downloaded and reviewed. Using a set of quality measures identified from literature review, we assessed each app for 4 features: basic characteristics, content source, functionality, and security. Frequencies for each feature were recorded, and percentages were calculated. RESULTS: Twenty apps intended for use by RA patients were identified in December 2016. Fifty percent of apps (n = 10) offered only symptom tracking. Five (20%) provided only information about RA, and 5 (20%) engaged patients by providing both symptom tracking and educational information. Fewer than 50% of apps provided means to contact health care providers or link to an online community, and only 6 (30%) offered security protection for the user. CONCLUSIONS: Most current RA apps do not provide a comprehensive experience for individuals with RA. Areas for optimization include the implementation of smartphone accessibility features and secure methods of protecting individual health information.

A Novel Mobile App and Population Management System to Manage Rheumatoid Arthritis Flares: Protocol for a Randomized Controlled Trial.

BACKGROUND: Rheumatoid arthritis flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled health care provider visits and are, therefore, difficult to monitor and manage. We sought to develop a mobile phone app combined with a population management system to help track RA flares between visits. OBJECTIVE: The objective of this study is to implement the mobile app plus the population management system to monitor rheumatoid arthritis disease activity between scheduled health care provider visits over a period of 6 months. METHODS: This is a randomized controlled trial that lasts for 6 months for each participant. We aim to recruit 190 patients, randomized 50:50 to the intervention group versus the control group. The intervention group will be assigned the mobile app and be prompted to answer daily questionnaires sent to their mobile devices. Both groups will be assigned a population manager, who will communicate with the participants via telephone at 6 weeks and 18 weeks. The population manager will also communicate with the participants in the intervention group if their responses indicate a sustained increase in rheumatoid arthritis disease activity. To assess patient satisfaction, the primary outcomes will be scores on the Treatment Satisfaction Questionnaire for Medication as well as the Perceived Efficacy in Patient-Physician Interactions questionnaire at 6 months. To determine the effect of the mobile app on rheumatoid arthritis disease activity, the primary outcome will be the Clinical Disease Activity Index at 6 months. RESULTS: The trial started in November 2016, and an estimated 2.5 years will be necessary to complete the study. Study results are expected to be published by the end of 2019. CONCLUSIONS: The completion of this study will provide important data regarding the following: (1) the assessment of validated outcome measures to assess rheumatoid arthritis disease activity with a mobile app between routinely scheduled health care provider visits, (2) patient engagement in monitoring their condition, and (3) communication between patients and health care providers through the population management system. TRIAL REGISTRATION: ClinicalTrials.gov NCT02822521, http://clinicaltrials.gov/ct2/show/NCT02822521 (Archived by WebCite at http://www.webcitation.org/6xed3kGPd).

Feasibility of a Tablet Computer System to Collect Patient-reported Symptom Severity in Patients Undergoing Diagnostic Coronary Angiography.

BACKGROUND: Percutaneous coronary intervention is the most commonly performed revascularization modality for chronic stable angina, but does not improve survival or reduce major adverse cardiovascular event. Percutaneous coronary intervention in this population is performed primarily for symptomatic benefit; therefore, symptom reduction is an important marker of quality. Patient-reported outcome measures (PROMs) have been developed for chest pain and dyspnea which are valid and responsive to treatment; however, they are not widely used in routine care. We present a model for use of PROMs in routine care. METHODS: Partners Health System funded a tablet computer software platform to collect PROMs and include them in the medical record. We implemented this platform in the catheterization laboratory at Massachusetts General Hospital, targeting patients presenting for coronary angiography. Patients are assessed using the SAQ-7, the Rose dyspnea scale, the PHQ-2, and the PROMIS-10. We used a phased implementation, with the final program including preprocedure measurement, presentation of data to clinical providers, and follow up using an email platform. RESULTS: We successfully captured measures from 474 patients, 53.5% of outpatient visits. Key success factors included high-level leadership support and resources, a user-friendly interface for patients and staff, easily interpretable measures, and clinical relevance. CONCLUSIONS: We have demonstrated that routine capture of patient-reported symptom severity is technically feasible in a real-world care environment. We share our experiences to provide others with a model for similar programs, and to accelerate implementation nationwide by helping others avoid pitfalls. We believe expansion of similar programs nationally may lead to more robust quality infrastructure.