Personalised symptom entry websites may lower cognitive demands on healthcare providers: a qualitative study with primary care staff (Preprint)

BACKGROUND Patients often communicate with primary care centres remotely (e.g. by telephone or e-mail) before seeking in-person care. Some patients and providers are not fully satisfied with these routes. A novel route is to develop a patient-facing symptom entry website, which streamlines the subsequent triage process for clinicians. However, it remains unclear what the optimal set of features might be for such systems, and what benefits they may bring to providers. OBJECTIVE To evaluate a patient-facing personalised symptom-entry website (developed by Certific OÜ, Estonia) for its acceptability to primary health care providers. METHODS In-depth interviews were conducted in 8 primary care centres in Estonia, covering 8 nurses and 6 doctors, 3-6 months after the implementation of a novel patient-facing website. RESULTS The software was well received by the staff with all interviewees expressing desire that more patients initiate their remote query via the website. As compared to an e-mail request, the software was reported to satisfy staff concerns for privacy and data security which they felt to be important; save provider time and effort needed for gathering sufficient detail for triage; and helped structure patient symptom descriptions to free provider time from having to synthesize free-text. Staff concerns about safety with the new software were effectively alleviated by implementation decisions to integrate the new software alongside telephone requests. Challenges reported by staff included the effort needed to get patients to use the website. While previous research has criticised poorly-designed multiple-choice systems, our findings suggest that an appropriately designed and personalised multiple-choice system is preferable to healthcare staff, as it lowers their cognitive demands, workload and may enhance workplace wellbeing. CONCLUSIONS Interviewed primary healthcare staff felt that the symptom entry and information condensing system designed by Certific was highly acceptable and desirable. They particularly valued a perceived reduction in cognitive demands. This holds promise for increasing staff wellbeing, reducing provider workload and increasing efficiency, which could be assessed in future studies.