Background/Purpose: Treatment of patients with rheumatoid arthritis (RA) is guided by monitoring changes in disease severity. At present, patients do not routinely record disease severity between clinic visits, despite the availability of a range of validated patient reported outcome measures (PROMs). In response this, the REMORA study (REmote MOnitoring of Rheumatoid Arthritis) is developing and evaluating a Smarthphone app which patients can use to record key ePROS (electronic patient reported outcomes) between clinic visits, and link these to the electronic patient record (EPR). The aim of this analysis is to examine patients’ views of using the beta version of the app and explore its impact on their post-app clinical consultation. In particular we were interested in seeing if the app could overcome some of the limitations of the current consultation process, i.e. reliance on patient recall, eloquence and stoicism regarding their symptoms between clinic visits.

Methods: The ‘beta app’ was tested by eight patients for one month during which they completed routine question sets at home, with the data integrated into the hospital EPR. Question sets included seven visual analogue scales for daily symptoms including pain and fatigue; weekly self-reported count of tender and swollen joints, flares, and impact on work; and monthly completion of the health assessment questionnaire (HAQ). A free text diary function was provided for ad hoc recording of information, although this wasn’t exported into the record. Patients were invited to a clinical consultation ‘pre’ and ‘post’ app use. These were used to determine the value of having access to routinely recorded ePROS at the consultation. Individual interviews were held with participants to discuss their experience of using the app and the use of the data as part of the clinical consultation. Feedback was also obtained from the consulting clinician.

Results: Patients’ felt that the app was “a great idea” and made care “more personal to you”. Data recording improved the consultation as it aided recall and made it easier for patients to have a “shared conversation” with the clinician at the consultation as “with a graph…you can see what’s going on.” “I found it made a difference, because it wasn’t all me telling him and trying to remember. The information was there so you’ve got solid proof straightaway” These views were echoed by the consulting clinician as the ePROS made it possible to quantify responses to treatment across physical and mental health. The graphs highlighted flares that patients hadn’t mentioned, and demonstrated gradual improvements in symptoms in response to treatment that may otherwise have been missed, therefore supporting decision making regarding the continuation of treatment. Routine completion of data was relatively straightforward – “it’s a doddle” – and not too onerous. A number of minor refinements to the app design and question sets were suggested by patients and will be incorporated into the app.

Conclusion: The app was well received by patients and feedback suggests that the data recorded will have a number of benefits for both patients and clinicians.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-experiences-of-using-a-smartphone-app-for-remote-monitoring-of-rheumatoid-arthritis-integrated-into-the-electronic-medical-record-and-its-impact-on-consultations/