title: Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency.
abstract: OBJECTIVE
  The objective of this evaluation study is to assess a web-based application, currently available on iPad, to document questionnaires regarding patient reported outcomes such as quality of life. Based on the single source approach, the results of these questionnaires are available in the electronic health record to be used for treatment and research purposes. The assessment focuses on the usability and efficiency of the system.
  
  
  METHODS
  The system usability scale questionnaire with seven additional items was used to rate the usability by the patients. It was formally validated by a Cronbach Alpha test. In addition, semi-structured interviews were conducted with patients and medical staff. Time and cost measures, based on official tables of costs, were taken through workflow observations. This study was conducted in the department of dermatology at the University Hospital of Münster, Germany from April to June 2011.
  
  
  RESULTS
  Using the web-based application questionnaire, results about patient reported outcomes like quality of life are immediately available in the electronic health record and can be used for treatment or research purposes. 118 patients and four staff members participated in the study. The usability score reached 80 from 100 points and patients as well as medical staff stated in the interviews that the usability of the web-based system was high, and they preferred it to the previously used paper-based questionnaires. In the setting of our pilot department the mobile devices amortized their costs after 6.7 months. In general, depending on the professional group who are going to post process the paper-based forms, the earliest break-even point to use mobile questionnaires is at 1737 paper sheets per year.
  
  
  CONCLUSIONS
  The mobile patient questionnaires, integrated into the electronic health record, were well accepted in our pilot setting with high usability scores from patients and medical staff alike. The system has also proved to be cost-efficient compared to the paper-based workflow, given that a certain number of questionnaires is used per year.
authors.affiliation: Institute of Medical Informatics, University Münster, Albert-Schweitzer-Campus 1/A11, 48149 Münster, Germany. Fleur.Fritz@uni-muenster.de
authors.forename: Fleur
authors.initials: F
authors.lastname: Fritz
authors.forename: Sebastian
authors.initials: S
authors.lastname: Balhorn
authors.forename: Markus
authors.initials: M
authors.lastname: Riek
authors.forename: Bernhard
authors.initials: B
authors.lastname: Breil
authors.forename: Martin
authors.initials: M
authors.lastname: Dugas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D034201:Computers, Handheld / Q000191:economics* / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D057188:Workflow; D055815:Young Adult