A Pilot Comparison of Clinical Data Collection Methods Using Paper, Electronic Health Record Prompt, and a Smartphone Application

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Figure 1.
Examples of the 3 card methods: paper, EHR, and app. The questions on the cards are shown as an illustration of how cards are used, and responses to the card questions are not evaluated in this manuscript.
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Figure 2.
Cost of card development and data managing by card modality. Development and deployment costs based on paper (copying, distributing, and collecting paper cards), EHR (building the alert in EHR and questions in REDCap), and app (adding questions and primary care clinician e-mail addresses, supporting users with app download). Data management and tech support costs based on paper (manual data transcription from paper to Excel), EHR (download data from REDCap, upload and data cleaning in Excel), and app (clinician support, onboarding, download data from app, upload data in Excel). For each modality the column on the left indicates actual, measured cost for this study. The columns on the right for each modality indicate the estimated cost for using 400 cards per modality. The paper cards do not scale as well due to large amounts of time required to transcribe data manually. EHR and app cards scale much better with minimal increase in data management time.

Table 1.

Primary Care Clinician (PCC) Demographics (n = 15)

Variable	Item	Count (n = 15)	Percent (%)
Gender	Female	12	80.0%
	Male	3	20.0%
Age	25 to 50 years old	8	53.3%
	>50 years old	7	46.7%
Degree	Physician (MD or DO)	12	80.0%
	Advance Practice Provider (APRN or PA)	3	20.0%
Years as a PCC	1 to 10 years	5	33.3%
	11 to 20 years	5	33.3%
	>20 years	5	33.3%
Patient contact hours per week	4 to 16 hours	5	33.3%
	17 to 24 hours	3	20%
	25 to 32 hours	4	26.7%
	≥33 hours	3	20.0%
Business model	Affiliated with academic medical system	11	73.3%
	FQHC, RHC	4	26.7%

Abbreviations: FQHC, Federally qualified health center; RHC, rural health center.
All PCCs were white, non-Hispanic.

Table 2.

Primary Care Clinician (PCC) Participant Experience from the Follow-up Survey, by Card Modality (n = 12)

	Card Modality
PCC Experience*	Paper Mean (SD)	EHR Mean (SD)	App Mean (SD)	χ² (P-value)^±
The card study did not disrupt clinical operations or patient care	4.7 (0.6)	3.8 (0.5)	4.3 (0.5)	4.4 (0.11)
The card method was easy to use	4.7 (0.6)	3.8 (0.8)	4.5 (0.6)	2.9 (0.24)
I felt good about participating in this card study	3.7 (1.5)	4.0 (0.7)	3.5 (0.6)	0.9 (0.63)
In the future, I would like to participate in additional card studies	3.7 (1.2)	3.8 (0.8)	4.0 (0.8)	0.4 (0.83)

↵*Participant experience questions were on a 5-point Likert scale ranging from 1 = Strongly disagree to 5 = Strongly Agree.
^±Kruskal-Wallis non-parametric test was used to identify differences among the 3 independent card modality groups.
Abbreviation: EHR, Electronic health record.