The dynamic question modules of ConsultAssistant in practice

How can a doctor easily obtain the right information about the patient's health complaints and situation so that doctor and patient can together make the right treatment choices? And how do you ensure that you collect the right information with a low administrative burden in order to improve care in a value-driven way?

With these questions as a starting point, ConsultAssistent has developed 'dynamic question modules'. How these modules work, we can best explain with a practical example (an animation of this practical example can be found here: ENT practical example):

"Peter is a 35-year-old man. He moved from the UK to the Netherlands a few years ago. His Dutch is not very good yet. Peter has an appointment with the GP because he has been dizzy for some time. The GP refers Peter to the ENT doctor because of his dizziness symptoms. The hospital receives the referral, with a letter of referral, and makes an appointment for Peter with Dr. Van Houten.

Peter is automatically invited for an ENT autoanamnesis of ConsultAssistent a few days before the appointment with Van Houten. The automatic invitation is possible because ConsultAssistent is linked to the EPD, based on characteristics such as appointment code and speciality, it is determined for which patient an invitation is needed. ConsultAssistent is also integrated with the Personal Health Environment (PGO) of Peter. Peter immediately receives a notification in his PGO that an invitation for a preparation for the outpatient appointment is ready for him.

Via the link in this invitation, he opens the autoanamnesis and at home Peter answers questions in ConsultAssistent about his health problems and care needs. He sets the language to English and indicates in ConsultAssistent that, besides dizziness, he now also suffers from headaches. The auto-anamnesis module only asks Peter the anamnesis questions (in English) relevant to the combination of dizziness and headaches. Peter indicates that he has been somewhat depressed lately and therefore automatically receives the HADS (Hospital Anxiety and Depression Scale) questionnaire. He scored below the threshold for suspected anxiety and depression disorder.

Peter's answers show that he suffers from four characteristics associated with the diagnosis of PPPD (persistent positional perception dizziness). PPPD is a relatively recent diagnosis, so it can still be missed. Peter therefore receives the validated NPQ questionnaire[1]. 1] This is a questionnaire specifically for diagnosis and outcome measurement of PPPD. He scored above the threshold on all three PPPD subdomains.

In the auto-anamnesis, Peter also mentions that an MRI scan of his head was made 4 years ago in another hospital. He gives permission in ConsultAssistant for this other hospital to share the results of the MRI examination with the ENT specialist. The policlinic is informed about Peter's permission and can immediately download a permission letter.

Two days later, Peter comes to the hospital for his appointment. Beforehand, Doctor Van Houten takes less than half a minute to look at Peter's autoanamnesis report that is in the EPR. This report is in Dutch, is clear and in short medical terms.

Van Houten immediately notices that Peter suffers from four characteristics of PPPD and also scores high on the NPQ. During the consultation, Dr. Van Houten continues to ask about Peter's autoanamnesis. After additional examination, she concludes that the most likely diagnosis is PPPD. The headaches are caused by Peter's anxiety about his dizziness. Van Houten complements the autoanamnesis in Peter's file with her own findings and conclusions. Because Van Houten could ask more specific questions and needed less time for reporting, there is more time to talk about Peter's treatment and prognosis.

As Peter's auto-anamnesis did not give rise to any suspicion of an anxiety and/or depression disorder and this was also not apparent from the interview, Van Houten and Peter decide to only use vestibular rehabilitation as treatment. Without additional antidepressants. Peter is referred to the physiotherapist in the hospital and a follow-up appointment is scheduled with Dr Van Houten in four months' time.

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A complete overview of all questions and answers, as well as the concise report for the doctor, are also available in PDF/A format in the PBM. As a result, the hospital complies with module 2 of VIPP5. The elements from the autoanamnesis for which ZorgInformatieBouwstenen (ZIBS) are available have also been made available as ZIBS for the EPD.

One week later, Peter has his first appointment with the physiotherapist. Beforehand, Peter again receives an invitation from ConsultAssistant in his PBX. Peter answers (again in English) questions relevant to vestibular rehabilitation. Some of the questions overlap with the questions that Peter answered earlier in the autoanamnesis for ENT. Peter does not need to answer these questions again because there is only a few weeks between the two entry points. The previous answers are reused and Peter can modify them if he wants to. The physiotherapist starts the treatment and it goes well. During the rehabilitation treatment, the physiotherapist uses ConsultAssistant to monitor Peter's perceived progress.

Four months later, there is a check-up with doctor Van Houten. In preparation, Peter receives a new invitation in his PGO. In the follow-up question module, he answers questions about how his dizziness and headache symptoms are doing now. Peter reports that the dizziness has largely disappeared and the headache is completely gone. Because Peter previously scored above the threshold, the NPQ is again part of the questions. Again, he no longer scores above the threshold. After Peter's response, Doctor Van Houten receives a report from ConsultAssistant that Peter is hardly bothered by the symptoms anymore. She looks at the follow-up report in the EPD and decides that Peter does not need to come to hospital for a check-up. She asks a policeman to consult with Peter and change the appointment to a telephone appointment.

A few days later, Peter has a telephone appointment with doctor Van Houten. He tells us that he feels "much better" now, that he has the dizziness well under control and that he is very happy with the telephone appointment. Besides saving him a trip to the hospital, he did not have to take off work this morning.

Doctor van Houten became very interested in PPPD and wanted to do more research on better PPPD diagnosis. In addition to Peter, over 4,000 other patients at the ENT outpatient clinic of this hospital used ConsultAssistant in the same year, 350 of whom also had dizziness complaints and consented to the use of their pseudonymised data for research. Besides the patients of this hospital, there are thousands of other patients with dizziness complaints in several other hospitals for whom relevant data is available. Doctor Van Houten decides to do research together with an AIOS and has a fantastic database at her disposal".

In this practical example, we have shown how the dynamic question modules of ConsultAssistent support doctor and patient during the entire care process. With ConsultAssistent, the doctor has the right information from the patient at the right moment to make an effective diagnosis and monitor the treatment results. The patient is better prepared by thinking about the relevant questions in advance. There is also automatic decision support that helps to realise the right care in the right place. And all this is fully automatic.

The outcome information of all patients is collected in a structured way together with the context from the auto anamnesis as part of the treatment. This information is not only valuable for determining the best treatment for the individual patient but is also essential for improving care in a general sense. In this way, the actual added value of outcome measurements can be optimally utilised without increasing the registration burden.

[1] Yagi C, Morita Y, Kitazawa M, et al. A Validated Questionnaire to Assess the Severity of Persistent Postural-Perceptual Dizziness (PPPD): The Niigata PPPD Questionnaire (NPQ). Otol Neurotol. 2019;40(7):e747-e752