Documentation is one of the most time-consuming, laborious, but necessary parts of medicine. If technology existed that enabled us to document all our thoughts, rationales, examinations and actions through the course of the day automatically, we may be able to see significantly more patients than we currently are able to. Being able to quickly look up pertinent information would also expedite our day, as digging through patient charts for old histories eats up precious clinic time.
Anamnesis aims to help physicians annotate their thoughts more easily. It provides an organizational structure that allows physicians to input information covering a broad range of categories, ensuring that all of a physician’s thoughts can be input into this universal iOS app. Note that Anamnesis is not an electronic medical record; its purpose is to allow physicians to jot down their thoughts for transfer to a proper medical record at a later time.
Multiple patients can be entered into Anamnesis. Pressing the “+” button will create a new visit history, automatically dated according to today’s date. Within each visit history, a wide range of demographics, findings, parameters, test results or notes can be filled in or left blank according to how the visit went.
Patient demographics can be entered under the “general information” tab. Identifying information such as name, birthdate, religion, place of birth and profession can be stored here. This information carries over with the patient to subsequent visit histories, so if you create a new visit history, these fields will be automatically populated with information from the previous visit.
Clinical history and physical exam data can also be entered. Unlike the patient demographics though, this information is specific to each visit, so if you create a new visit history, these sections will be blank again.
Lab tests and imaging can also be described here via text or by taking an actual picture of the image and uploading it to the visit history. Unlike some of the EMRs I’ve used however, the labs and images are not compiled into a specific section for easy viewing, so to look up old results one must go through each specific visit history. (images created from Visible Body)
The complete visit history can also be easily exported into PDF format for easy emailing. Unfortunately as demonstrated in the picture below, the app automatically puts different sections on separate pages, so the output can end up being unnecessarily large with many blank spaces. This makes for difficult skimming, and if printed out, can also waste a lot of paper and space if added to a paper chart.
Since Anamnesis is a universal app, it also works on iPhone. The app works more or less the same as on iPad, with all features present.
While Anamnesis organizes the information gathering process well, I feel it fails in a few key areas that ultimately keep it from being a useful app in the clinic. Its main objective is to help physicians quickly annotate key data from patient encounters. Traditionally, physicians will talk to the patient while writing in the chart; talk to the patient and write a progress note at a later time; or talk to the patient and dictate later.
In order for the app to be useful, it has to be faster than at least one of these scenarios in order to draw users. In the clinic, many physicians will write in a paper chart or type into an EMR while speaking. While this can draw physicians’ attentions away from the patient, it does ensure that everything is documented as it happens, and minimizes the amount of charting needed afterwards.
When compared to these methods of documentation, Anamnesis falls short. Typing on an iPad or iPhone simply isn’t as fast as writing on a piece of paper, typing on a computer keyboard, or dictating. And recording information in the app isn’t the same as getting the information into the medical record, so users jotting notes down in the app will have to copy the information to the record at a later time anyway.
The app just adds an extra step, which neither increases speed nor accuracy. Printing the information off from the app can also result in excessive multipage histories which can clog up paper charts. For clinicians who prefer to document patient encounters as it happens, this app has little to offer them.
For the other group of physicians who prefer to document at the end of the day, this app may be helpful for quickly jotting down key notes for each patient. Physicians can review their notes in the app at the end of the day to help with documentation.
However, this again raises the question of whether jotting down these notes into the app or writing it out on a piece of paper is faster. While Anamnesis organizes the information neatly, typing into an iOS device nevertheless is usually slower than writing on clipboard. The main advantage of the app is its organization and legibility (when compared to messy physician handwriting). It can be used to replace scribbling onto random bits of paper, but time is a scarce resource in the clinic, and I do not believe this app will save time compared to traditional methods of information recording.
Lastly, there remains the issue of HIPAA compliance to ensure that health information is protected. Some technologies such have FaceTime have been reported to be HIPAA compliant. We have reached out to the developers some weeks ago regarding this issue, but have not received a reply specifying whether this app is HIPAA compliant.
Without a clear answer, it is difficult to recommend the usage of this app, at least in the United States. The information I have entered for the purposes of this review are completely fictional and do not represent the findings of any particular patient I have encountered.
If you decide to use this app, please check with the laws of the country you are practicing in, and perhaps use pseudonyms or other ways to ensure that the information you enter into the app cannot be traced back or used to identify a patient. Doctor-patient confidentiality is an important tenet of our profession, and we must take all reasonable steps possible to protect it.
Overall, Anamnesis is a good attempt at improving the workflow of physicians, but it ultimately does not prove to be quicker than traditional writing, typing or dictating. This coupled with its unknown HIPAA compliance status makes it difficult to recommend to clinicians.
- Good clean organization
- Typing into an iOS device does not prove to be much faster than traditional input methods (writing, typing, dictating)
- Will likely have to copy app information into a proper medical record anyway, adding an additional step
- Unknown HIPAA compliance status
Healthcare providers that would benefit from the app:
Anamnesis has identified an area of improvement in the workflow of physicians, but speed and HIPAA concerns make it difficult to recommend.
Rating: (1 to 5 stars) 2.25 stars
User Interface: 3
Multimedia Usage: 3
Real world applicability: 1