Award-winning health care app updating paper questionnaires to smartphone age

A group of doctors in St. Paul has been cutting down on unneeded urological surgeries by considering answers on questionnaires patients fill out about their pain.

The Fairview HealthEast Kidney Stone Institute considers the process part of a shared decisionmaking process, but replicating those kinds of results elsewhere is difficult. The paper questionnaires used at the institute are clunky for the patient and cannot be uploaded to electronic health record (EHR) systems.

Now, a joint project between the Kidney Stone Institute, the University of Minnesota and a private company called Perk Motivation has developed an app called Prism intended to streamline the questions for patients and make the resulting data accessible inside EHRs.

This week, the Prism app took top honors in a federal competition called the Step Up App Challenge that included 50 different groups vying to design the best digital system for delivering standardized questionnaires to patients and the resulting data to doctors.

"I think it's a really good example of how all the different stakeholders in the health care landscape can come together to create an innovative solution," said Zach McGill, founder and CEO of Perk Motivation in Minneapolis. "We've got people that are clinicians, health care admins, academics from several different areas of the University of Minnesota, as well as industry, all coming together to create a solution."

The idea started at the U, where experts in the Medical Industry Leadership Institute (MILI) at the Carlson School of Management recruited partners at the Institute for Health Informatics at the Academic Health Center to team up and compete in the Step Up App Challenge, run by the federal Agency for Healthcare Research and Quality, or AHRQ.

AHRQ has been working to influence how digital health tools can be incorporated into the health care system to bring down costs and improve quality and patient satisfaction.

Officials at AHRQ saw that validated questionnaires for a wide variety of conditions can be used to provide standardized patient feedback to help clinicians get a more objective view of patients' symptoms over time, leading to better outcomes. But it's not easy. The questionnaires are long, and they are printed on paper.

The Kidney Stone Institute's old-school paper questionnaires were used as part of a care protocol for kidney stone patients who went to the ER in extreme pain.

Those patients got expedited referrals to the specialty institute, where the questionnaires were used as part of shared decisionmaking with the patient to decide whether to get surgery or pass the stone naturally. Even with survey results tallied manually outside of EHR systems, the results were notable.

"We were able to drop the rate of surgery for kidney stones … by really understanding what we needed to do to improve people's discomfort," said Dr. Andrew Portis, medical director of the institute. But, he said, "you shouldn't have to be a specialized institute to use these tools."

The institute was brought in to advise on how the questionnaires could be made easier to use via a downloadable application on a patient's personal device. And then Perk Motivation, a two-person startup with a pre-existing relationship with the U, was brought on to design the app.

The resulting application isn't limited to urology questionnaires — it can be used with many conditions that require regular visits to the doctor, but would benefit from more frequent interaction than that.

For example, pain levels and mental states can fluctuate greatly between visits, but the patient might not have much recall of those past sensations and how they affected daily quality of life during a monthly or quarterly office visit.

The Prism app takes down patients' answers in real time and automatically enters them into the EHR.

"As a health economist who deeply cares for using data to infer value of health care interventions, the idea of having a user-friendly app and receiving data directly from patients is a fascinating opportunity," said Pinar Karaca-Mandic, academic director of the MILI at Carlson. "It allows for incorporating patients' voices in our value frameworks and helps evaluate patient outcomes."

Prism will be rolled out for pilot testing soon at MedStar Health sites on the East Coast.

Joe Carlson • 612-673-4779