Closing the Gap between Patients and Doctors: Benefits of Daily Symptom Tracking in Rheumatoid Arthritis via a Smartphone App Integrated into the Electronic Health Record

The Remote Monitoring of Rheumatoid Arthritis (REMORA) study is a smartphone study by the Centre for Epidemiology Versus Arthritis, designed to support both clinical care and research. It allows people living with rheumatoid arthritis to report daily symptoms using a smartphone app with data integrated directly into their electronic health record.

The problem: fragmented and limited data

One in four people in the UK live with a long-term condition^[i]. Like in many other long-term conditions, patients with rheumatoid arthritis only see their doctor once every six months or so. Those rare visits and brief consultations fail to deliver a clear picture of patients’ symptoms and disease progression. Patients struggle to recall and summarize symptoms after such long periods of time and the short consultation does not allow them to go into much detail.

This gap between patients’ symptoms and fragmented clinical data connected to rheumatoid arthritis inspired the need of a new technology-based solution.

The solution: REMORA smartphone app

The REMORA smartphone app was co-designed with patients, clinicians and researchers to improve the collection of patient-generated health data. With daily, weekly, and monthly questions, patients consistently entered data about their health status and symptoms over a period of three months. With a simple and easy to use app patients were able to quickly score their symptoms, such as pain and fatigue, from 0 to 10. The data was then uniquely sent into their personal electronic health record – something that has not been achieved before. In parallel, it was also sent into a research database after personal identifiable information were removed. The smartphone data in the health record was then visualised in simple graphs of symptoms, allowing doctors and patients to make shared, personalised decisions.

The specific benefits of using remote monitoring of the symptoms for people living with rheumatoid arthritis included:

• providing the “bigger picture” of rheumatoid arthritis by identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed
• enabling person-centred consultations allowing doctors and patients to look together at trends of symptoms through time and make shared decisions
• empowering patients to organize and self-manage their own health

REMORA provided accessible, reusable, and reliable data that can successfully be integrated into the health records for the benefit of patients, clinicians, and researchers. Furthermore, it creates an unprecedented opportunity for the development of a patient data repository and connecting infrastructure as a blueprint for integration of patient generated data into NHS records.

A demo version of the REMORA app is available to download here.

More information on the study can be found here and in this short video. The full publication is available here.

This project was funded by Versus Arthritis and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester.

[i] Department of Health. Long Term Conditions Compendium of Information. London: Department of Health,2012. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf (2 June 2019, date last accessed). Google Scholar