Listening to patients: recording their own conditions and symptoms through smartphone applications

Managing symptoms and treatment side effects is very important, particularly for people with chronic (persistent) diseases. However, physicians sometimes cannot detect patients’ symptoms and physical impairments when they attend clinics. Opportunities to intervene are consequently missed, and pain, for example, may not be adequately relieved.

Many hospitals now keep patient information electronically rather than in paper files. As expected, this offers many advantages. Hospital automation systems have been able to do this for years. In recent years, however, another notable development in electronic health records (EHRs) has emerged: patients taking an active role in treatment! This is called “self-management” or, more commonly, “patient-reported outcomes” (PRO).

It is difficult to manage something that cannot be measured

Thanks to recent advances in technology and survey methods, e-health applications such as patient-reported outcomes (PRO), using smartphones and simple but methodologically robust assessments, promise better patient care. Physicians can thus receive automatic notifications about concerning symptoms or functional impairments, such as severe pain, shortness of breath or heart failure with reduced physical activity. During patient visits, they can review PRO reports in detail and transfer that information into their own EHR notes as part of a systems assessment. Evidence suggests this approach improves quality of life and the patient–physician relationship, reduces emergency visits and prolongs survival.

A study comparing emergency visits and survival in cancer patients using and not using a patient-reported outcomes (PRO) system. The study included patients receiving chemotherapy, 766 cancer patients in total. Some received usual care, while others used a PRO system to record their symptoms regularly online. Severe or worsening symptoms were emailed to nurses. Patients using PRO ultimately visited emergency departments substantially less often, survived longer and had better quality of life. Nurses responded to symptoms in %76 of patients with clinical actions such as telephone advice or new prescriptions.

Although few hospitals worldwide have successfully integrated PRO into clinical practice so far, this will become more widespread. Allowing patients an active role in their treatment will improve adherence and reduce treatment side effects, ultimately increasing treatment success and satisfaction. The first requirement is to share information and developments about these applications and create awareness.

Electronic health records integrating patient-reported outcomes aim to provide better healthcare.