Supporting Heart Transplantation Aftercare through Mobile Access to Medical Records: Feasibility and Usability of the App “phellow” (Preprint)

BACKGROUND Giving patients access to their medical records can improve health literacy, adherence to therapy, patients’ health-related self-care, doctor-patient communication, and quality of care. The application (app) phellow (“personal health fellow”) was developed to provide patients with mobile access to selected content of their medical records (i.e. physician letters, drug trough levels). It was tested at the heart transplantation (HTx) outpatient clinic at Heidelberg University Hospital among volunteer patients after heart transplantation from late 2018 onward. OBJECTIVE The aims of this study were (1) to assess whether the phellow app can be effectively used by all participating parties (usability) and (2) to determine if the app is feasible to be further implemented in routine care (feasibility). METHODS Usability was quantitatively measured through the System Usability Scale (SUS) among patients who actively used phellow. In addition, usability and feasibility were qualitatively measured through semi-structured guide-based interviews with patients (users, non-users) and health care providers (medical staff, physicians) from the HTx outpatient clinic. Quantitative data were analyzed descriptively and through correlation analyses. Qualitative data were pseudonymized, audiotaped, and transcribed verbatim. Themes were identified through thematic analysis. RESULTS The usability rating measured with the SUS questionnaire (n=31) was 79,9 (SD 14,1) which indicates a high usability. No statistically significant correlation was found between SUS scores and patients’ age, gender, or frequency or duration of phellow use. A more in-depth view on usability and feasibility was obtained from interviews with 16 patients (5 non-users, 11 users) and 7 health care providers (HCPs; 4 medical staff members, 3 physicians) (n=23). App appreciation, interest, and willingness-to-use were high. Tasks fit with clinic workflow and were perceived as clear. An improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were requested for further implementation. Usability problems such as incompleteness of record, incomprehensible presentation of content, technical issues (e.g. sudden app crashes), and complex registration procedures were reported. Participants recommended usability improvements (e.g. chronically plausible presentation of record content, simplified registration and log-in) and suggested new functionalities (e.g. access to full record, communication module, appointments, medication refill requests). CONCLUSIONS Despite some usability issues, usability of the phellow app was considered high. To be feasible for an implementation in routine care, usability problems should be solved. Accompanying research is crucial to monitor usability improvements and to assess effects of app use on patients and clinic workflow.