Direct to Consumer

ePoster Presentation

(EP-129) An Exploratory Case Study of Patient Interaction with Direct to Consumer Teledermatology Apps

Sunday, April 23
4:15 PM - 4:30 PM
Location: Experience Zone - ePosters

Objectives
Describe the use of “Thinking Aloud” and Direct Observation protocols in evaluating software interfaces.
Identify app features that may facilitate patient interaction and those that do not.
Recognize app interfaces affect the accuracy of information patients submit and, consequently, the accuracy of diagnostic consults


Methods
A patient with a skin problem used five different popular and frequently downloaded teledermatology apps from the Apple App Store to enter information about his condition. An aid took photos requested by the app because the lesion in question was on the back of the patient’s neck. No additional assistance was provided. The patient’s navigation through each app interface was observed and the patient was encouraged to talk about what he was thinking in the course of interaction. Photos and information were uploaded with each app. The patient was also seen in-person and diagnosed with folliculitis.



Results
Four apps returned results, three of which matched the in-person diagnosis, one app diverged greatly from the others. None of the apps followed textbook guideline for taking history. The patient had more problems with open ended apps with only free text entry that assumed lay persons can appropriately describe their problems. The patient had problems responding to information solicited, especially with queries having clinical terms. Apps with structured inputs, such as pick lists, were helpful, but only if choices offered were not too technical. Apps that were inflexible and that would not let the patient proceed without input were particular frustrating and prone to eliciting guesses when the patient did not know how to respond. If pick lists or yes/no and multiple choice questions are presented, patients should have the option of indicating they do not know or answering in their own words.


Conclusion
Other studies have found low accuracy with teledermatology apps. This exploratory study suggests why. The single case identified several app features facilitating and hindering interaction that might affect accuracy that warrants further study with additional patients. Guidelines for app design are needed based on sound clinical practice and well-established principles from human-computer interaction research.

Matthias Kochmann

Clinical Informatics Fellow
Regenstrief Institute

Clinical Informatics Fellow at the Regenstrief Insitute in Indianapolis, IN. Enrolled in the master for Biomedical Informatics at the Oregon Health and Science University, Portland, Oregon. Practicing Pediatrician, trained at the Children's Hospital of the State University of New York, Brooklyn, NY. Medical degreee in from Semmelweis University in Budapest, Hungary.

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Craig Locatis

Project Officer and Educational Research Specialist
National Library of Medicine

Dr. Craig Locatis is a project officer and educational research specialist who leads a research team at the National Library of Medicine studying collaboration technologies in healthcare with a special focus on telemedicine and distance learning applications. He has authored or co-authored over 50 peer reviewed publications and is a member of the Scientific Board of the journal Computers in Human Behavior and a contributing editor for the journal Educational Technology Research and Development. He is a recipient of the National Institutes of Health Award of Merit and of the Health and Science Communications Association Special Achievement Award. Prior to leading a research team, he was Project Officer for NLM funded projects exploring applications of high performance computing and communications in healthcare and, in pre-Internet days, helped establish a National Demonstration Center for Interactive Technologies within the Library. He also served as Project Officer of a US State Department/National Library of Medicine partnership establishing Internet connectivity for the national medical libraries of nine newly independent states of the former Soviet Union.

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(EP-129) An Exploratory Case Study of Patient Interaction with Direct to Consumer Teledermatology Apps



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