Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19.</jats:p> </jats:sec>

COVID-19 Mobile Apps: A Systematic Review of the Literature

“…The age of participants was also reported in most of the studies except 3 [ 28 , 31 , 33 ]. The average age or age range for participants varied depending on the corresponding study.…”

“…One paper [ 25 ] described how the hospital information system was adapted to handle COVID-19 with the incorporation of relevant templates. An app for recording general health information was discussed in 1 paper [ 33 ], and apps for self-assessment focusing on symptoms were found in 1 paper [ 32 ]. Self-monitoring based on a symptom diary and health observation data were also reported in 4 papers [ 26 , 29 , 32 , 33 ].…”

“…An interactive map of user demographics and health status was discussed in 1 paper [ 32 ]. Two apps offered data sharing capabilities via email to specific recipients based on patient options [ 33 ], or as symptoms were worsening, the app sent messages to be assessed by nursing staff to provide appropriate advice [ 29 ]. One paper assessed student behavior to determine whether the mental health of participants changed due to the COVID-19 pandemic [ 24 ].…”

Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study

“…Virtual health care screening as well as chatbots and mobile applications 17,18 are unlikely to refer asymptomatic individuals for testing. Without sufficient capacity for rapid, inexpensive testing, screening efforts may be hampered and accurate measurement of incidence and prevalence will be challenging.…”

Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach

“…A number of countries have integrated this kind of tracing app into their deconfinement plans or are presently discussing this option [ 2 , 3 ]. Research has concentrated on contact tracing and symptom tracking systems [ 1 , 4 - 6 ] as well as the association between app usage and the epidemiological spread of the virus [ 7 ]. Some studies have focused on the differences between apps implemented in several countries [ 3 ], while others have analyzed the legal or ethical aspects (eg, data protection) [ 2 , 8 , 9 ].…”