A new web-based e-tool is designed to be a focused diagnostic and treatment aid and to improve communication between patients and their physicians.
A new and innovative health care website is launching in the first quarter of 2012. ProMyHealth, a non-profit organization, will offer a novel, free, online service to collect high-level, detailed histories from patients via a HIPAA-compliant website and generate a narrative report that patients can then bring to their physicians. This report will summarize the relevant points of the history, point out possible red flags, and give the most likely clinical impression based on the available patient history. The developers expect that this report will increase the efficiency of new patient visits and revisits and help focus the interview, thus allowing more time for examination, discussion, treatment planning, and counseling.
ProMyHealth will use headache as its initial model. The headache section will contain up-to-date, useful information about headache, including descriptions of headache types, state-of-the-art treatment tools, answers to common questions, short chapters and articles, useful links, a list of headache specialists by state and city, audio and video clips, and a novel tool to facilitate and improve communication between patients and their physicians.
Patients will have their histories taken via an extensive, easy-to-use, validated, expert questionnaire that will produce anywhere from 80 to 360 data points, depending on the patient’s responses. The resulting report will read like a consultation from a headache expert, including red flags and an analysis of historical elements that meet established diagnostic criteria and lead to the most likely clinical impression based on the history alone. Standard treatment options will be readily available to the patient and doctor on the website.
The database is searchable in a program that does not contain any patient identifiers. With the patient’s permission, the physician can go online to see which answers support the clinical impression and which do not, as well as selected questions by topic. The website and physician report are careful to point out that the system does not make a diagnosis, since that can only be done by a physician after a physical and neurological examination and appropriate testing. Instead, the report is intended as a tool to aid physicians in arriving at a diagnosis and treatment plan, based on an extensive history from the patient taken in the privacy of his or her home or office with reference to accepted diagnostic criteria. Few physicians have the time to obtain this amount of information from a patient during an office encounter.
The questionnaire uses branch chain logic and was developed by headache specialists Rob Cowan, MD, Professor of Neurology at Stanford University, and Alan Rapoport, MD, Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA, with the help of Professor James Blythe, PhD, an expert in artificial intelligence programming at the University of Southern California, Los Angeles. Initiated through an unrestricted grant from Merck, the project has been four years in the making. Validation studies were presented in poster sessions at the 2011 annual meetings of the International Headache Society and the American Headache Society. A much larger outcomes study to determine whether this e-tool will save time and money and be acceptable to both the patient and doctor is in the design stage and will begin shortly after launch.
Modules for memory dysfunction, depression, anxiety, sleep problems, and chronic pain are nearing completion, and others are in development. All modules use the algorithm developed for the headache questionnaire. The ability to incorporate the narrative into electronic medical records such as EPIC is being perfected.
Drs. Cowan and Rapoport anticipate that the narrative will save physicians significant time, improve accuracy of data and documentation, increase retention, and benefit patients as a step edit between the primary care provider and referral to the specialist. This should empower both primary care providers and neurologists to handle more headache patients on their own with less need for referral. The tool should also save time for headache specialists and allow them to spend more time on focused points in the history and less time on detailing every previous medication taken and every unrelated point in the past history.