- Electronic Diaries and the Problem of Patient Compliance
- A Case Study – Electronic Diary for Orphan Disease of Hemophilia (Bleeding Disorder)
- Improvement of Patient Compliance Through Voice Control
- Example: Prophylaxis Documentation via Smartphone App
- Comparing to Prophylaxis Documentation via Voice Control
Electronic Diaries and the Problem of Patient Compliance
Electronic diaries on smartphones are enjoying increasing popularity among health apps. Whether it is a calorie diary for the treatment of obesity or a diary for the telemonitoring of a rare chronic disease. The only problem: Patients use the app in the first weeks as planned. However, over time interest and consequently patient compliance decrease. Thus, the diary loses the quality required for monitoring by the doctor. A major reason for poor compliance is often the cumbersome keyboard entry via the smartphone app. Just a few clicks, for recurring diary entries, demotivate the patients. For example, many patients consider the login with username and password to be “too cumbersome” in the long run. Patients demand a maximum of ease of use. Therefore, usability is a critical success factor for electronic diaries.
A Case Study – Electronic Diary for Orphan Disease of Hemophilia (Bleeding Disorder)
For many years, the diary smart medication™ has been used for telemonitoring the orphan disease of hemophilia. Patients document their prophylaxis treatment and bleeding events in a smartphone app or via a web browser on the computer. Prophylaxis is performed at home by injection of the missing factor medication by the patient himself. The patient injects a factor preparation at regular intervals, e.g. every 2-3 days. Ideally, well-adjusted patients will then no longer bleed spontaneously. The patient normally always documents the same medication, i.e. the same product and the same dose. The doctor can follow the course of therapy via an online portal and, if necessary, contact the patient and ask him to visit the treatment center. Obviously, regular and complete documentation by the patient is particularly important for this type of supervised treatment.
Improvement of Patient Compliance Through Voice Control
It is obvious to use natural language for entering and maintaining an electronic patient diary. There are a number of arguments in favor of this:
- Natural language has a high information density. This means, just a few words are enough to formulate a complex command. In the context of smart medication™, for example, the command “new prophylaxis” is sufficient to describe and document recurrent treatment.
- If a speech recognition device (e.g. Amazon’s Alexa Echo) already exists and is used at home, it is obvious that it can also be used for a patient diary application like smart medication™.
- A stationary speech recognition device installed in a domestic environment can also be addressed directly from a distance and, unlike a smartphone, does not have to be found and picked up first.
- A tolerant implementation of the voice commands also allows for the use of similar phrases and terms. For example, the command “new prophylaxis” or “new syringe” leads to the same result as the command “document prophylaxis”.
- The use threshold is low for people who already use voice control.
- The treatment of chronic diseases, e.g. by injection of a syringe, often takes place at home.
On the other hand, there are also a number of disadvantages:
- People who do not yet have a speech recognition device are unlikely to purchase and set up a device exclusively for maintaining an electronic diary.
- Mostly, young people (digital natives) prefer voice control. Older people (digital immigrants) often reject this form of human-machine interface.
- Due to the partial lack of transparency of the underlying service providers (such as Amazon, Apple, Google or Microsoft) and with regard to data protection and the statutory general data protection regulation (GDPR) in the EU, the processing of health data using service providers outside the EU is particularly questionable.
Example: Prophylaxis Documentation via Smartphone App
Entering a prophylaxis treatment on the smartphone usually requires the following steps:
- Pick up and switch on the smartphone
- Enter an unlock code (up to 8 clicks)
- Start the smart medication™ app (1 click)
- Login with patient-ID (5-digit number) and a password (min. 4-digit number) (min. 10 clicks)
- Select “Prophylaxis Documentation” in the menu (1 click)
- Put in or correct the date and time of prophylaxis treatment (up to 10 clicks)
- Check the preset drug and dose
- Send the input data (1 click)
In summary, at least 20-30 clicks on the keyboard and widgets such as buttons, spinners, drop-down list boxes, etc. are required. Although this procedure is easy to follow, some patients find the documentation “too complicated”. Especially since the input every 2 or 3 days is basically identical. Experience shows that the lower the input effort, the better the patient compliance.
Comparing to Prophylaxis Documentation via Voice Control
Prophylaxis treatment using voice control is much simpler than entering data on a smartphone. The entire process requires only three simple voice commands:
- “Open smart medication”-command to start application
- “New Prophylaxis”-command to document a prophylaxis treatment
- “Yes”-command to confirm the transaction
The use of alternative voice commands leads to the same result and enables the intuitive use of patients with different dialects and language use.
Alternative Speech Intends to Document Prophylaxis Treatment
- “document a new prophylaxis”
- “new prophylaxis”
- “document a new prophylaxis treatment”
- “new prophylaxis treatment”
- “document a new treatment”
- “new treatment”
- “document a new syringe”
- “new syringe”
Speech recognition allows even faster treatment documentation into smart medicationTM electronic diary compared to the usage of the smartphone app or the web browser. The objective of optimal patient compliance including instant and complete treatment documentation can be further improved by using natural language and a speech interface into electronic diaries. However, not all patients will accept speech recognition equally (digital native vs. digital immigrant). Also, data protection issues have to be discussed thoroughly and patients need to be fully informed what risks are potentially associated with speech recognition services and its manufacturers. However, developers should consider speech recognition as an additional alternative, beside smartphone app and web browser, to access and manage electronic diaries by patients.