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IntroductionElectronic medical records are becoming increasingly popular. This is because it is easier to use information that is stored in this way. While reading the database, there is no problem with blurred writing or faded documents. The information may be partially validated and therefore contain less errors. Furthermore, it is easier and faster to send, collect and protect against sudden loss .The need to collect digital patient data has made people create electronic patient data collections called Electronic Health Records (EHRs) . The software that allows for the creation of EHR differs depending on which specialist and for what purpose is it used. For example, requirements are different for a GP than for a physician who collects information on the move. The common properties of this type of application are the following: the desire to provide maximum protection for patient data, the data transfer function and the ability for the user to read data in programs other than those where the record was made .The application being the subject of the article, Comprehensive Geriatric Assessment, is an example of a program for mobile work that works on Android system. The physician using the application must fill out the card next to the patient’s bed. There are many programs that allow to collect patient’s data using mobile devices (e.g. QxMD and ZnanyLekarz.pl), but our application is the first that will allow physicians to conduct this kind of survey with elderly patients.Materials and methodsOne of the databases created by doctors working in hospitals and in the ambulatory care is a database based on material from the Comprehensive Geriatric Assessment (Figure 1). It is a multidisciplinary diagnostic tool which was designed to collect data on the medical, functional and psychosocial capabilities and limitations of older adults. This questionnaire allows to identify the patient’s health and social problems and plan for future treatment and rehabilitation . The form used in the application is recommended to be performed among the elderly in hospital and outpatient settings [5, 6]. This questionnaire contains selected scales including the Mini-Mental State Examination , Katz Index of Independence in Activity of Daily Living , the Lawton Instrumental Activities of Daily Living Scale , the VES-13 Scale , the Tinetti Test , the Geriatric Depression Scale (short version) , the Norton Scale  and the Clock-Drawing Test . Summarized results from these parts are recorded in the Comprehensive Geriatric Assessment . This card also contains the patient’s personal information and the results of prognostic studies. To complete the entire card, it is necessary to fill out about 130 fields included in the questionnaires.Figure 1:The side of the base material.The material used to write the application was completely included in the program, but two of the tests in which the patient has to draw pictures were omitted because the patient must be asked to do them outside the application and only the doctor has the right to evaluate these tasks and fulfill the form with scored points in the program. It was necessary to omit these tests because of the reluctance of many older people to work with the computer . Failure to perform a patient’s drawing on a computer would mean lack of ability to manipulate a tool, not a disorder.If the tool was to be compatible with the tablet, it was possible to make an application tailored to the system on it (which limited the ability to run your system) or create an offline web-based application (there was a risk of losing data integrity, browser dependency and status). Taking into account all factors, the option of creating a customized application was chosen.According to data collected in 2015, the most popular operating system installed on tablets was the Android system (Google, Mountain View, CA, USA) (62% of tablet users used this system) ; therefore, the application was dedicated to this system. Ultimately, the app was supposed to work properly on three of the most popular (according to the 2015 statistics ) versions of this system – Lollipop, Kitkat and JellyBean.Finally, the application was made using following technologies and programs:Java and XML for Android – programming languages in which application was writtenSQLite – database management systemJDK 7 (Java Development Kit) (Sun Microsystems, Santa Clara, CA, USA) – the environment in which the development of the program took placeAndroid Studio v. 2.0 (Google Mountain View, CA, USA) – The integrated development environment selected for building applications.Application tests ran on three types of devices. They were different versions of the system and the diagonal of the screen.ResultsFunctional requirements, attached at the beginning of work, have been fully realized. The ready program allows to do the following:Create three types of user accounts:Administrator – the doctor that first launches the application and goes through the account creation process. It has the ability to manage other users (add, delete and edit their data), manage surveys (add, delete, edit and email) and edit its account.A doctor – this account can create an administrator. The doctor has the ability to manage surveys and edit its account.Nurse – a user that does not have an outflow on survey. It can only read and send test results.Log in to the application.Create, edit and delete a patient record.Create new accounts for the staff (from the administrator account).View completed questionnaires.Upload patient record via e-mail.The scheme of the program looks as follows. The person who first created account on the system must have given a proposition of login and password (for security reasons, the password must be eight characters, consisting of uppercase and lowercase letters and digits). The application checks to see if the fields are properly filled out. After logging in administrator can add a user. This process is as follows. Administrator selects “Add User” then enters the new user’s name and e-mail address and determines whether the user has limited privileges. Finally, the program checks to see if the fields are filled out. After completing the fields, the program generates a login and a user password (the user will have to change the password after the first login attempt). The login is made up of all the letters of the first and last name (if a user with the same name exists in the database, a random number is added to ensure that the login is unique).Another option is to delete the user. For this purpose, the administrator must provide the user’s login. It is checked whether this person is in the database and, if yes, is deleted. The administrator cannot be removed from the system.The third possibility is to edit your own data. It allows you to change your password and enter a new e-mail address. The new password is validated.Adding a survey is the most important feature of the program (Figure 2). Actually, this operation is done when the menu panel is loaded. Then, it is checked whether there is no survey in the database which was not saved (which could be a result of sudden closure of the application). If it exists, it will be removed (it could be possible to create a so-called working copy of the questionnaire thanks to the existence of such a record in the database) and a blank template for the questionnaire is created.Figure 2:Screen shot showing adding a survey.In practice, the table replaces tables that have the status “unsaved”. Adding a new patient is possible after entering a Polish national identification or PESEL number that does not exist in the database and after completing the fields name and surname. Filling out the rest of the fields is not mandatory. All tests were split between 12 activities. Figure 3 shows one of these activities.Figure 3:Screen shot showing part of the survey.If there is no need to enter text, the physician can give a patient response by pressing the appropriate button. This form of data entry allows completing the test as quickly as possible. Points in the test are automatically saved and summed. At the end of this process it is possible to save or reject the questionnaire. An important feature that improves work comfort is that the user can return to previous activities without having to fill out the survey fields again; all the data he has previously submitted are substituted for the relevant questionnaires.The survey edit option makes the user, after providing the patient’s PESEL number, go through the same process as when adding a survey. The difference is that the PESEL number will not be revalidated and the survey will be filled out with the data recorded in the tables.Another option available in the menu is to view the survey (Figure 4). Once the patient’s PESEL number is entered in the tables, the questions and answers or points received by the patient will be displayed in response to the data.Figure 4:Screen shot showing summary of patient data in the application.The last operation a user can perform is to send the results of the survey. Based on the patient data, an xcl file with summary information is created. It is necessary to have an external application that supports e-mail to send the survey. The created file can be opened and viewed from this level and printed.Currently, it is possible to use the application. For this purpose, please download it from the site https://drive.google.com/open&id=0B2hVBiTCv8n5aWVodFJ5WjJDMXM (Polish version) or https://drive.google.com/open&id=0B2hVBiTCv8n5c2hfR19QVEdEcjQ (English version).Detailed information regarding the flow of information (during events) in the application can be found in the supplementary material.TestsThe application was presented to a group of five people including two doctors, a medical student, a pharmacist and a nurse.Each person was given a tablet with the installed application and a list of tasks that must be performed. The list included commands for creating an account; starting a program with different users’ permissions; adding, completing, viewing and editing a poll; configuring account; and adding and removing other users’ accounts.After the tests, it turned out that for three people the most difficult was to create an administrator account. It was problematic to find a password that consisted of eight characters including upper and lower case letters and numbers. However, everyone acknowledged the pop message that appeared after the initial attempt to set a password (it contained information about what is missing in the password). One person reported a problem while editing the poll – the tester chose to open the survey and was trying to edit the field (which is impossible). An inactive button and an error in adding one of the polls were found. All the bugs that the testers have noticed have been fixed.Two testers pointed out that there should have been possibility to add more surveys for one patient. One of the testers expressed general reluctance to use the tablet.Despite the problems mentioned above, the application has been recognized by four people as easy to use. An easy concept was to have a simple menu and a general concept for filling out the survey.ConclusionsThe application provides all the necessary functions for comfortable working conditions.The fact of implementing a program can controversial, i.e. creating a tool that is only available on Android devices, but the choice of the means to create the application was determined by the assumptions that were made prior to the implementation of the program, i.e.The need for mobile work (the doctor interviews moving between patients’ beds)Data integrity protectionPossibility of non-network access (temporary or permanent)The safest solution was to create an application that could not be accessed via a publicly accessible network (or anonymization and data separation before being saved and sent – in this case, the process would be very difficult due to the amount of sensitive data and it was difficult to do because of human resources). Also, the choice depended on the fact that access to the network could be difficult and the tool had to work independently of the network. The disadvantage of this solution was the problem of sharing data and limiting the use of the application to one device.This version is the first version of the application and has only basic options. Another version of program could provide additional opportunities. What could be found in the next version are the following:Possibility to collect aggregated patient information that could facilitate the statistical analysis of aggregate patient information that could be followed up by statistical analysis in later stagesCollective import of patient dataCreating editable fields in the table that appear when you select “Open Survey”Highlight in red color the results that indicate a patient’s health problemsPossibility to add more surveys for the same patient and insert a survey option (so-called patient history)Save the database with the patient’s patient data on a different storage medium than the one where the test results are storedPlacement of print options in the main panelSaving drafts of survey workThese subheadings can easily be added to the program. This app is designed so that in most cases, it is necessary only to the appropriate lines of code to the program without much interference in the code that already exists.Author contributions: The authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.Research funding: None declared.Employment or leadership: None declared.Honorarium: None declared.Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.References1.http://tiny.pl/g5msp. Accessed: 29 Jan 2017.http://tiny.pl/g5mspAccessed: 29 Jan 20172.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550638/. Accessed: 29 Jan 2017.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550638/Accessed: 29 Jan 20173.http://rocznikikae.sgh.waw.pl/p/roczniki_kae_z29_34.pdf. 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Bio-Algorithms and Med-Systems – de Gruyter
Published: Dec 20, 2017
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