Developing a mobile epilepsy management application integrated with an electronic health record for effective seizure management

Highlights

• The study developed and evaluated an mHealth service for managing epilepsy compatible with the hospital’s EHR system.

• Functions such as seizure Diary, Medication, Appointments, Survey were developed to aid patients’ epilepsy management.

• The usability test showed participants were highly satisfied with the service despite differences between task success rate.

• The degree of perceived importance of the functions differed by participants’ characteristics.

Abstract

Introduction

Epilepsy is a chronic neurological disorder characterized by recurrent spontaneous seizures. Over 70% epilepsy patients can live normally if their seizures can be controlled. For this, many factors should be tracked and managed, but doing so is hard because of individual differences. There are mobile applications to help track these factors; however, no application covers crucial factors comprehensively, and they are complicated to use. Therefore, this study aimed to develop a mobile epilepsy management application covering crucial factors comprehensively in a user-friendly way. We evaluated the pilot version with a usability and satisfaction survey and an interview.

Methods

We established a task force comprising professionals from various fields who participated in all processes of this research. Existing service analysis and professional interviews were conducted to draw a function list. User interface and graphic user interface were designed under the supervision of the task force. After developing the application’s pilot version, usability and satisfaction of the application were evaluated with eight patients and caregivers through scenario-based usability test, satisfaction survey, and interview.

Results

All existing mobile epilepsy management applications provide seizure and medication diary functions. We decided to provide six main functions: seizure diary, medication reminder, appointments, outpatient survey, education materials, and personal dashboard (My epilepsy). We also integrated the application with the hospital’s electronic health record system. To simplify usability, frequently used and relatively important functions are located in the main page as “seizure recording” and “medication diary.” Additionally, when designing graphics, art therapy was used to enhance psychological stability. For evaluation, eight participants were recruited. In scenario-based tasks, among 10 tasks, all participants completed six tasks. However, only 37.5% participants could record seizures in detail. System Usability Scale score was 84.5 points, indicating that the system was satisfactory.

Conclusion

This study confirmed that patients’ satisfaction of this application were high. Additionally, it helped them record their seizures accurately, which is very useful for seizure trend analysis, discovering seizure trigger factors, and ensuring efficient management of epilepsy. Through integration with the electronic health record, patient medical information could be utilized to guide physicians’ decision-making for setting future medical treatment plan and could contribute greatly to the overall management of epilepsy.

Introduction

Epilepsy is a chronic neurological disorder characterized by recurrent spontaneous seizures. The worldwide prevalence of epilepsy is estimated to be 0.4–1% [1]. Due to abnormal brain activity, certain seizures cause convulsion or loss of consciousness and result in injuries. In addition, such damage can result in traumatic brain injury, broken bones, concussions, and breathing problems [2].

Over 70% epilepsy patients can live their lives without major problems if they have the appropriate means to control seizures [3]. Medication is the most common treatment among numerous interventions [4]. However, it is challenging to determine the appropriate treatment to control seizures for each patient, as the disorder is highly complex, and each patient has different physiological status. To determine which medication regime is appropriate, physicians initially suggest some medications for trial. If the first trial is effective without serious side effects, patients continue the medications. If not, physicians suggest other medications as an alternative until they find the active ones [5]. To reduce time and ensure efficiency, information concerning seizure status, medication side effects, dose history, and seizure trigger factors should be tracked continuously [6]. Therefore, patients or caregivers note these in their own way, such as on paper or on their mobile phones, to show physicians. This is very inconvenient for the patients to record and difficult for physicians to read and infer associations [7].

To address these issues, many mobile applications including EpApp [8], EpiWatch [9], and Seizure Sync [10] have been developed. These provide seizure diary and medication reminders in common. Additionally, depending on applications, various functions are included such as educational materials, emotion diary, and automatic seizure detection. There are many factors to be addressed for managing epilepsy, but there is no application covering all these factors comprehensively. Moreover, there is no application integrated with the hospital’s electronic health record (EHR) system, which is crucial for usability. This not only makes it hard to communicate with the physician but also degrades usability. Puneet et al. recently demonstrated that although the number of mobile epilepsy management applications is increasing, their functional coverage is still limited [11]. Another review of mobile epilepsy self-management apps also noted this and suggested the need to develop mobile epilepsy management apps that provide broader domains of functionality to support self-management [12]. Usability is particularly important in the design and development of health applications to ensure their adoption and sustained use, as users tend to quickly abandon applications when facing inconvenience (e.g., problems in access and complex processes) [13]. Therefore, a usability test is a useful evaluation method to detect fatal usability problems before releasing the application [14].

Therefore, the primary objective of this study was to develop a mobile epilepsy management application that comprehensively covers crucial factors for managing epilepsy. As a secondary goal, considering usability, we tried to enhance the application’s convenience through a simple user interface (UI), graphic design, and integration with the hospital’s EHR system. To draw a list of functions, interviews with professionals from various fields and existing service analysis were conducted. Moreover, integration with the hospital EHR system was processed to reduce user effort in typing data such as prescribed medicine and lab results and improving communication with physicians. In addition, UI was designed as simple as possible. Art therapy was adopted in graphic design for helping users feel psychologically relieved. After developing the pilot version of the application, a scenario-based usability test, satisfaction survey, and interview were conducted.