When Sharing Sensitive Info, Patients Prefer App vs Staff: Study

Patients using a tablet-based app were more than twice as likely to disclose depression, intimate partner violence, and fall risk compared with verbal screenings, according to a new study.

The study, published online today in JAMA Network Open, includes the use of mPath, a tablet-based app created by a team of researchers at Wake Forest School of Medicine.

Researchers studied the use of the app at six primary care practices among patients age 18 years or older. The app, which exists on a tablet that's given to patients at check-in, includes screening questions for depression, intimate partner violence, and fall risk that would otherwise be asked verbally by nurses. The results of the questionnaires are transmitted to a practice's EHR.

"We were surprised to find that the app detected so many more people with depression or safety concerns compared to when nursing staff were asking the same questions verbally," lead author David Miller Jr, MD, a professor of internal medicine and public health sciences at Wake Forest School of Medicine, Winston-Salem, North Carolina, told Medscape Medical News. "To put [the study results] in context, for every 10 patients who walked in the door, our app found one additional person with concerns that would have been missed."

Nearly 1 in 5 adults (52.9 million in 2020) in the United States experience mental illness, according to the National Institute of Mental Health; this can include mild to severe mental illness. Intimate partner violence affects approximately 1 in 4 women and nearly 1 in 10 men across the country, per the Centers for Disease Control and Prevention (CDC). The federal agency also finds that more than 43 million American women and 38 million men endure intimate partner-related psychological aggression in their lifetimes.

Meanwhile, approximately 36 million older adults fall in the United States each year and more than 32,000 seniors die as a result, according to the CDC. While the cause of the fall can range from poor eyesight to ill-managed diabetes to loose rugs, per the National Institute on Aging, the end result can be a broken bone, which can require a trip to the hospital, or even disability.

Integrating the App Into Practice Flow Is a Must

Patients perceive tablet-based screening as more private than in-person screening, according to the study. Because of this perception, patients are more likely to provide more sensitive information in an app, write the authors, who add that medical office staff are often busy, which can lead them to paraphrase screening questions.

Use of the app by front desk staff varied from 10.3% to 60.5% across the six practices, according to the study, which largely occurred because of how staff handed the tablet to patients.

"We designed the app to be given to every adult patient at every visit. So for us, optimal uptake would be using it at every visit," said Miller. "We tried to be very sensitive to [physician practices'] usual workflow."

Keeping the questionnaire brief increased the chances that a patient could complete it in the waiting room; on average, patients finished the program in less than 90 seconds, said Miller.

"We have learned that if you want busy healthcare professionals to use a program, it must fit into their usual workflows," he added.

As Data Is Shared With EHR, Alerts Catch Significant Results

Medical office staff are often busy juggling a variety of activities, which means they may not be focused on the patient doing the questionnaire and then miss reports about depression, intimate partner violence, or fall risk.

To address this, Miller's team ensured that nursing staff view a patient's responses in a pop-up in the EHR when they are transmitted from the app to the patient's chart. A nurse is required to scroll through each patient's responses and click on a button to accept them.

Another safeguard was making sure that physicians acted on significant results, such as a patient reporting severe depression or suicidal ideation, said Miller. Any significant results appear as a pop-up alert in the patient's chart when it's opened by the physician, he added.

Miller encourages physician practices to brainstorm about ways to incorporate technology to improve the efficiency and effectiveness of care. For example, if a nurse continues to ask the exact same questions of each patient, that could be an opportunity to use an app, he said.

The end results can include time savings and capturing even better information, according to Miller. "We found that our app can do just that. And we hope the time we save can be better spent addressing a patient's specific concerns."

More than 23,000 patients were included in the study, which captured data from June 2019 to February 2020. Researchers reduced the time period studied at two practices as a result of COVID-19 to avoid confounding. Nearly 60% (57.9%) of the patients included in the study were women, and the average age was 60 years. More than three quarters (81%) of the patients included in the study were White.

Aine Cryts is a veteran health IT and healthcare writer based out of Boston.

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