BACKGROUND: A patient-entered computerized history can be used as a means of medical data collection in a large inner city population. We evaluated whether a patient presenting to the Charity Hospital campus of the Medical Center of Louisiana in New Orleans would use a computer to provide medical information.
OBJECTIVE: To determine whether patients would self-administer a computerized medical history and find this an acceptable experience
DESIGN: A survey questionnaire was given to 100 patients selected from the emergency department walk-in clinic waiting area.
SETTING: Charity Hospital emergency room walk-in clinic
METHODS: One hundred patients older than 18 years were selected to give a random sample of the population using the Charity Hospital emergency room walk-in clinic for care. The patients received a questionnaire for rating their experience with the computer. Demographics were collected for all patients, including the 13 who declined participation. The main outcome was the patient’s perception of the acceptability of using the computerized medical history. A second important outcome measure was patient refusal to participate in the study.
RESULTS: Our analysis of the acceptability ratings revealed adequate internal validity (Cronbach a=0.75). A single total score was created for these ratings. The participants’ scores ranged from 2.0 to 4.0, with a mean of 3.3 (standard error of the mean=0.04). We observed an 83% positive experience in the participating population.
CONCLUSIONS: The patients were able to use the computer to enter their medical information. They responded favorably to the experience and appeared to be capable and willing to provide medical information through use of this technology.
The Charity Hospital system in Louisiana provides care for a population of medically indigent patients. The legislature has authorized Louisiana State University Medical Center-New Orleans (LSUMC–NO) to form a health maintenance organization to care for Medicaid patients and those who constitute the medically indigent population. Compiling a medical data set to manage such a population is difficult. In 1997 virtually all the medical data at LSUMC was buried in paper charts that were mostly handwritten by physicians and medical students. When our group found software for a self-administered computerized medical history, we thought this might be the methodology needed to gather essential medical data from our large population of patients. We decided to test this technology by seeking an answer to the question: Can and will a patient at Charity Hospital use a computer to give a self-administered medical history?
Methods
The walk-in clinic associated with the emergency room at Charity Hospital in New Orleans was used as the site of our study. It is open 15 hours daily during the week and 10 hours daily on weekends, and approximately 5500 patients visit this clinic each month. Patients were sampled during January, February, and March 1998 by calling the patient’s name whose record was at the bottom of the stack of charts of patients to be seen. These patients were invited to participate, and demographic data were taken and a reason for refusal was noted when possible for those who refused.
The computer system used was an IBM-compatible 486 PC with a color monitor and standard keyboard. The interview software was Instant Medical History (Primetime Software, Columbia, SC). The participants completed the brief version of the history algorithm to expedite the interview process, since our goal was not to test the software but to determine the patient’s ability to use and opinion of using a computer to give the information.
In the testing area the patient was given a consent form and a questionnaire. The patient completed the consent form and a set of items on the questionnaire before using the computer. The software used gave the patient instructions on how to input answers; the investigator typed in only the patient’s age and sex. When asked by the software to provide a reason for the visit, the patient was encouraged to select “New problem or illness” or “Follow up of previous illness.” Then the patient was offered more specific choices, such as: “Bone or muscle problem,” “Cough, cold,” and “Diabetes.” The investigators gave support for the patient’s use of the computer until selection of a system for the chief complaint was made. At that point the patients generally understood what to do to indicate the desired answer. Finding the letters on the keyboard appeared to be more of a problem than understanding the software. Interaction between the patient and the investigator was by design (none to minimal, while the patient was using the computer). After completing the history the patient answered another set of items on the questionnaire, was given the printout from the computer to share with his or her physician, and was returned to the waiting area. The general atmosphere was purposely cordial for participants and nonparticipants.