App takes a hack at streamlining review of symptoms


Where: The American College of Emergency Physicians' (ACEP) emergency medicine hackathon, held last October in Boston.

The issue: Reducing inefficiencies in the review of symptoms.

Background

During hackathons, teams of experts collaborate and try to improve known issues through technology and computer programming. The first hackathon was in 1999, and the first hackathon in health care was in 2010. Since that time, health care hackathons have grown exponentially, said John Manning, MD, an emergency physician at the University of Illinois at Chicago.

At ACEP's second annual hackathon, Dr. Manning and his team proposed a potential solution for a longstanding issue with care delivery: inefficient and redundant review of symptoms (ROS). The current system for filling out the ROS requires clinician time and often a high number of clicks, Dr. Manning noted. “To date, the ability for patients to enter their own review of systems electronically is novel,” he said.

Typically in the ED, a nurse will triage patients, asking basic ROS questions—checking if fever, cough, or chest pain are present, for example—before a more comprehensive ROS is conducted by a physician or advanced care practitioner, Dr. Manning said. “So you're asked some of the same questions as when you're seen by the nurse initially. That overlap is one of the things we were also seeking to address,” he said.

During the 3-day event last fall, the team created Rapid ROS, a mobile app where patients can quickly enter their symptoms and medical information on a phone or tablet. That information automatically transfers over to the electronic health record (EHR), which physicians then use to confirm the ROS at the time of the patient encounter.

How it works

The premise of the app is simple: Patients fill out the ROS while waiting to be seen, and the clinician reviews and confirms the information, with the option of making any necessary edits. “The novel part here is that you're making use of patient-generated data so that you're not having to ask the same questions over and over again,” Dr. Manning said.

The app could be applied anywhere that ROS is part of a patient's initial assessment, including inpatient admissions, outpatient clinics, and the ED, he said.

Information will flow from the app to different EHRs with the help of data standards, such as Fast Healthcare Interoperability Resources, said Dr. Manning, a fellow in clinical informatics. “You have something that you're working on here that, when you're done with it, will interface and import that information directly to the EHR and save you time,” he said.

How patients benefit

The main idea of Rapid ROS is to ensure that health systems are not duplicating work, Dr. Manning said. “From the patient's perspective, likely what they would see from this is that they're not being asked the same question back to back to back…. In essence, what we created was an app that allows patients to give their own voice, to get more involved, and to get engaged,” Dr. Manning said. “And from the clinician standpoint, it decreases some of the burden, that ‘click burden,’ so that we're not spending as much time as we are today doing basic data entry…. Any potential solution that can improve our usability will be well-received.”

The app also offers patients the convenience of completing an uncomplicated ROS while they're waiting to be seen, he said. “You have something that the patients can fill out in a way that makes sense to them…taken in a way that they can understand that is not in ‘medicalese,’” Dr. Manning said.

Challenges

The Rapid ROS team—Cyrus Yamin, MD; Smeet Bhimani; Phil Parker, MD; Angelo Kastroulis; and Sunny Chin—received the Best Emergency Medicine Solution Award and a $2,000 prize at the hackathon, but there's more work to be done before the app is ready for use. The team's next challenge is choosing which market to enter, Dr. Manning said. “Rapid ROS can easily go into outpatient, inpatient, and ED settings,” he said. “Which one do we target first?”

The challenge with any idea is implementation, but he and Dr. Yamin have already had success after ACEP's first hackathon, where their app to improve documentation in cardiac arrest won the grand prize. It's now almost ready for market, said Dr. Manning.

Next steps

The 4 key steps to bringing a technological innovation into practice are design, development, distribution, and the end user, Dr. Manning said. “The immediate next step in this is finalizing the design and making sure we have the right people involved in terms of development,” he said, noting that development also involves choosing a platform, such as iOS, Android, or the Web. “And when you go from a hackathon to an idea that you take to the next steps, the thing I would say [is] you have to make sure that you still keep the passion alive.”