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Are symptom checkers the future of self-triage? Key lessons from the Covid-19 pandemic

Previous articles have discussed the prominent role that telemedicine has played during the Covid-19 pandemic. Perceived risks of infection associated with in-person medical consultations and mounting pressures on healthcare systems have resulted in a substantial increase in the use of symptom checkers, digital platforms that utilize computerized algorithms to provide users with assistance in self-triage.1 Despite the limited knowledge available on symptom checkers,2 preliminary findings have highlighted their potential in reducing unnecessary visits and providing useful health information to users.3,4 Globally, Covid-19 symptom checkers were developed and shared by various Governmental institutions and corporations to provide the general public with a means of self-assessing their level of Covid-19 risk or help users identify the level of care required.5-8 Saudi Arabia’s Mawid app is an example of such a platform that allows users to self-assess their level of Covid-19 risk and schedule appointments in nearly 2,400 primary care settings in the Kingdom.9

To increase access and use, most symptom checkers are public-facing tools with the known exception of the University of California, San Francisco (UCSF) Covid-19 symptom checker, a tool that is fully integrated with patient medical records.3 Findings suggest that the UCSF prevented hundreds of unnecessary encounters by providing credible advice to patients allowing users to be triaged and, if needed, scheduled for an appointment in a median of two minutes.3 This requires the use of Electronic Health Record-tethered portals for enhancing the overall benefits of self-triage tools by enabling patients to view test results, communicate with their healthcare ream, and schedule appointments.3

While benefits of symptom checkers have become more apparent during the pandemic, their use for self-triage should persist post-Covid-19. Credible and validated symptom checkers can help prioritize medical consultations that have been deferred due to the pandemic. Preferably, healthcare settings would help inform the algorithms developed to ensure that prioritization is determined based on relevant parameters such as a patient’s reason for appointment and level of urgency or need for specialty healthcare services. The underlying aim of this approach is to identify individuals who need care the most by conducting a timely and convenient health assessment.

Symptom checkers have the potential to become a widespread tool used for self-triage; however, an important factor to consider is whether or not the population will accept and use symptom checkers even after the Covid-19 pandemic. History has taught us that it is unwise to develop or integrate a technology in healthcare if end users are not willing to accept and hence use the technology; such examples include electronic health records, a tool that took decades for widespread adoption by healthcare providers. As such, understanding the factors associated with symptom checker acceptance and use is pivotal to achieve optimal benefits from this relatively new and novel digital platform. One of the main factors associated with technology acceptance is age – young adults are typically eager adopters of technology and value timeliness and convenience in healthcare.10 Given that approximately 70% of Saudi Arabia’s population is under the age of 40, high adoption of self-triage tools is likely. Identifying additional factors unique to the population of Saudi Arabia is needed to optimize the use of symptom checkers and in turn, reduce unnecessary medical visits and healthcare costs.

Footnotes

Semigran HL, Linder JA, Gidengil C, Mehrotra A. Evaluation of symptom checkers for self-diagnosis and triage: audit study. BMJ. 2015 Jul 8;351:h3480. 

2. Aboueid S, Liu RH, Desta BN, Chaurasia A, Ebrahim S. The Use of Artificially Intelligent Self-Diagnosing Digital Platforms by the General Public: Scoping Review. JMIR Med Inform. 2019 May 1;7(2):e13445.

3 Judson TJ, Odisho AY, Neinstein AB, et al. Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19, JAMIA, ocaa051, https://doi.org/10.1093/jamia/ocaa051.

4 Meyer AND, Giardina TD, Spitzmueller C, et al. Patient Perspectives on the Usefulness of an Artificial Intelligence-Assisted Symptom Checker: Cross-Sectional Survey Study. J Med Internet Res. 2020;22(1):e14679.

5 Australian Government, Department of Health. Healthdirect Coronavirus (COVID-19) Symptom Checker. Australia, 2020. https://www.health.gov.au/resources/apps-and-tools/healthdirect-coronavirus-Covid-19-symptom-checker 

6 Government of New Brunswick. COVID-19 Self-Assessment. Canada, 2020. https://www2.gnb.ca/content/gnb/en/departments/ocmoh/cdc/content/respiratory_diseases/coronavirus/coronavirusexposure.html

7 Ada. Covid-19 Screener. Germany, 2020. https://ada.com/Covid-19-screener/

8 Babylon. COVID-19 Care Assistant. United Kingdom, 2020. https://www.babylonhealth.com/coronavirus/Covid-19-care-assistant

9 Government of Saudi Arabia. Ministry of Health, 2020. https://mawidstf.moh.gov.sa/

10 Canadian Medical Association. Shaping the Future of Health and Medicine. Canada, 2018. https://www.cma.ca/sites/default/files/pdf/Media-Releases/Shaping%20the%20Future%20of%20Health%20and%20Medicine.pdf

Stephanie Aboueid
Stephanie Aboueid

Senior Consultant, Healthcare
KPMG in Saudi Arabia