Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
J Med Internet Res. 2020 Aug 28;22(8):e18109. doi: 10.2196/18109.
Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient.
Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions.
A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work.
A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general.
Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.
数字医疗访谈助手（DMIA）系统，也称为计算机辅助病史采集（CAHT）系统，通过探索更多与患者相关的方面而没有时间限制，并因此在面对面咨询之前获取更多和更好质量的信息，有可能改善护理质量和医疗咨询。初级保健中的咨询在涵盖的主题数量方面是最广泛的，同时在与患者相处的时间方面也是最短的。
我们的目的是探索 DMIA 系统如何专门在初级保健环境中使用，以改善糖尿病和抑郁症的咨询，作为慢性病的范例。
进行了叙述性综述，重点关注（1）一般情况下的初级保健咨询的特征，以及具体的糖尿病和抑郁症咨询的特征，以及（2）DMIA 和 CAHT 系统对医疗咨询的影响。通过主题分析，我们确定了 DMIA 系统能够改善的初级保健咨询的特征。基于确定的初级保健咨询任务和 DMIA 系统的潜在益处，我们为糖尿病和抑郁症开发了一个示例问卷，以说明此类系统如何运作。
在第一次咨询之前，DMIA 系统可以帮助进行基本的初级保健任务，例如病例发现和筛查、诊断，如果需要，及时转介给专家或紧急护理。同样，对于后续咨询，该系统可以帮助控制和监测这些疾病，帮助检查其他健康问题，并向初级保健提供者更新患者就诊其他提供者或进一步检查的情况。成功实施这些任务的 DMIA 系统将提高所获得数据的质量，这意味着更早的诊断和治疗。这样的系统将改善面对面咨询时间的利用，从而简化互动，使重点放在患者的需求上，最终将导致更好的健康结果和患者满意度。然而，为了成功实施此类系统，需要考虑一些重要的因素，例如要使用的语言，以及在初级保健和一般医疗保健中实施电子健康创新的挑战。
鉴于这里探讨的益处，我们预计 DMIA 系统可能会对糖尿病和抑郁症的初级保健咨询产生重要影响，并可能对其他慢性病产生影响。由于更多和更好质量的数据，更早的病例发现和更准确的诊断，加上对疾病进展的更好监测，应改善护理质量，并将慢性病的管理保持在初级保健水平。一种简单、易于扩展的技术可以在改善数百万受慢性病影响的人的健康方面发挥重要作用，特别是如果与电子病历和临床决策支持系统等已建立的健康技术相结合的话。
