Digital anamnesis in thirty to forty questions

Doctor digital anamnesis

Can you predict more accurately how patients will fare if you know enough about them? Henk Blom, ENT specialist, is firmly convinced of this. For over twenty years, he has been working on a model and a tool that collects and analyses patient data in a structured manner and makes a more accurate prognosis possible. The result is ConsultAssistent. According to Blom, this tool improves the quality of care, makes triage more effective and gives the patient more attention.

Blom: "For patients with the same diagnosis, the outlook can be different. Take, for example, a child with middle ear infection. To make a prediction about the course of the disease, you have to take various factors into account. For example: what is the parents' history? Does a syndrome play a role? Does the child attend crèche? Do the parents smoke? Using the digital anamnesis from ConsultAssistant, we can map out all these factors."

"As a doctor, you have over a thousand questions to ask in order to reach a diagnosis, prognosis and treatment proposal. It is difficult to present all these questions to your patient. With a clever algorithm, we managed to reduce that number. In the case of MDL disorders, for example, the patient can indicate 1 to 14 possible complaints, after which around 40 questions are used to obtain a virtually complete medical history. Whether the generally older hospital population has no problems with the online questionnaire? "On the contrary, 80 per cent of them complete the anamnesis without any problems.

More focus on the patient

During the consultation, digital anamnesis cuts both ways, Blom knows from her own experience: "Patients come in better prepared. They think about the questions and discuss them with their surroundings. Specialists have the advantage that they only need to summarise the story and can respond to answers that require explanation. Ultimately, there is more time for what is really important to patients. What exactly is the diagnosis? What treatment suits efficient triage. What other processes are involved? And what is the prognosis?"

Also better for the patient: the digital anamnesis limits the number of hospital visits: "Based on the answers given beforehand, we can schedule examinations on the day of the consultation, for example. After treatment, we ask the patient to complete a follow-up questionnaire. Sometimes this can prevent a repeat visit."

Better quality of care

Apart from data collection, the power of a digital anamnesis lies in the data analysis, according to Blom: "We are developing a prediction model that shows which treatment choices lead to which treatment results. Thanks to the numerical support, as a doctor you can better indicate what your patients can expect. After all, they do not come for a diagnosis but for a prognosis.

"ConsultAssistant compares the results of different treatments and specialists. We receive direct feedback on our performance. You gain insight into missed diagnoses and together you can come to best practices. If the treatment results of clear patients show that treatment A leads to the same result as the more expensive treatment B, then the A choice is obvious."

More efficient triage and care

During the corona crisis, ConsultAssistant was also used for triage. According to Blom, it helps enormously if a medical history is available in advance. "Decision support ensures efficient triage. Other processes also run more efficiently. For example, patients are automatically invited through a link with the EMR and there is a digital informed consent."

"What also makes care more efficient is the central development and management of the digital anamnesis. This is complex and time-consuming. If each hospital does this itself, it is expensive and error-prone, so less secure."

Different specialities

Since the beginning of 2018, the ENT clinic has been working with ConsultAssistent. According to Blom, the ENT doctors are satisfied with the consultation process, which is experienced as qualitatively better and more efficient, as well as with the insight into the treatment outcomes. "Of the 8,000 patients who completed the digital anamnesis, we received a score of 8. Three quarters see the online questionnaire as valuable support during the consultation."

In addition to ENT doctors, other specialisms in hospitals throughout the Netherlands have embraced ConsultAssistant. "This year, we started with modules for traumatology, proctology, mammacare and MDL. Anaesthesia, dermatology, pulmonary diseases, neurology and ophthalmology will soon follow.

Interview with Henk Blom by Marcel Butterhof. Henk Blom is an ENT doctor and co-owner of ConsultAssistent.

Source: ICT&health nr. 03/2020 pp 11