Development of a Cell PhoneBased Headache Diary

1
Development of a Cell Phone-Based Headache Diary
Akihiro Takeuchi,1 Karin Ogawa,2 Noritaka
Mamorita,3 Noriaki Ikeda,1 and Fumihiko Sakai2
1 Department of Medical Informatics, School
of Allied Health Sciences, Kitasato University,
Japan 2 Department of Neurology, School of
Medicine, Kitasato University, Japan 3
Graduate School of Medical Sciences, Kitasato
University, Japan
Discussion Mobilization has become a major trend
and mobile devices offer great potential for
improving quality in health care (9). It has
proved to be of significant advantage to the
healthcare provider as compared to the
paper-based system (10). However, the user
interface of the system might be simple and
appropriate even in the small screen of a cell
phone. It is essential for the system to be easy
to use. Very strong efforts of the system design
made the input canvas and plot canvas to simplify
the users operation. The application only
recognizes numeric keys where a numeric value
should be entered minute, hour, dosage, etc.
Alphabetic characters are only used to enter
comments. A menu is automatically shown when
answers are ready. These functions do not allow
any error messages that are objectionable to
appear when entering data. The simple system is
useful as a real time recording tool. Though the
menus are predefined and the patient can modify
the menus for his or her own prescriptions, the
simplicity of the usage depends on conceptions of
the menu or questionnaire made by researchers. We
revised the questionnaires and added new
questionnaires to be able to record periods
patients suffer from headache (Figure 10). Our
application imposes upon the user to manually
enter his or her own clinical data and allows
them to edit the data at anytime. This
application can automatically construct graphs by
using stored records. The operation and graphics
may deepen patients awareness of their symptoms,
laboratory data, diseases, and prescriptions for
self-managing therapies. Porter et al. (2)
developed a booklet of a headache chronicle and
suggested that daily reporting was therapeutic
for some of the participants. It would be
interesting to test the hypothesis that the diary
may have a positive influence on the headache
course (1). The act of consciously entering and
organizing data may be relevant to promoting
desired behavior changes (11). The system shows
daily data and trend graphs of all plot items
together on a calendar canvas. However, the
system could be improved on the plot routines, as
many daily records take approximately 1 second to
make a graph of the data for each
day. Conclusion This headache diary on a cell
phone could be useful for patients with chronic
headache, since actively processing and managing
data may improve their understanding and
situational awareness. Our cell phone application
will record medical events at anytime and
anywhere in a persons life.
Results PC screens are shown in the regular order
of usage rather than using photographs of cell
phone screens (Figure 2). The application
operates like a scheduler. Today, on the
calendar, is highlighted in yellow. The selected
day is highlighted in light blue and moved by the
operating arrow keys. Each colored line on any
day corresponds to each clinical event or the
data and appears with comments and/or a graph in
the lower area. Three records, pairs of the
time of day and prescriptions (records), are
shown in Figure 3. Pushing the select key on a
target record shows a data entry canvas with item
names (medications and questions) and their
values. Numeric data are typed in by the patient.
An adaptive submenu is automatically shown on the
right side of the item along with headache
intensity (Figure 3, middle) and medications
(Figure 3, right). All these values, including
the time span, can later be edited. Detailed
graphic displays are sequentially shown on a
calendar canvas (Figure 4). Figure 5 shows a
daily graph of headache intensity, analgesics and
headache pharmaceuticals on the 19th. A trend
graph of headache intensity during 1 week is
shown in red (Figure 6). A mild intensity is
shaded in light red. Figure 7 shows a dosage of
medication for 1 week. A horizontal scale of the
graph is set to day, week, month or year by
pushing 2, 5, 8 or 0, respectively. Graph
properties of each item (vertical scale, normal
range, line color, line mode and symbol) can be
customized via a submenu on the calendar canvas.
On a selection canvas, items to be plotted are
marked with a black diamond (Figure 8). A submenu
of the calendar canvas includes functions
setting the system font, controlling infrared
communications, customizing item/plot items,
copying and pasting records, etc. Items
(medications, prescriptions, questions,
laboratory data, etc.) can all be customized,
added or deleted for each patients diseases.
Records are transmitted via infrared module into
a PC. The records are automatically tallied on
Excel (Figure 9). The application was adapted
for several patients in one trial. The patients
were positive about this application and said
that they would like to continue using it.
Materials and Methods The main purpose of the
cell phone application is to help the patient
understand their own diseases. Brief summaries of
the application requirements are (1) simple
usage with easy installment, (2) visualization of
clinical data to help understand their chronic
diseases and therapies, (3) simple customization,
and (4) automatic tally of recorded data on a PC.
The application was designed as a self-control
tool for patients who are familiar with cell
phone applications such as games. The application
is based on a scheduler consisting of 3 canvases,
a calendar, data entry, and a plot canvas, and
memory control and infrared modules (Figure 1).
Many optional values of the recorder are simply
modified by the patient for their diseases.
Abstract As headache diary has been effectively
used for the clinical evaluation of headache, the
application of IT technology may offer a
convenient tool for the self-management of
headache. We developed a cell phone-based
headache diary to observe patients condition
continuously and to facilitate the self-control
of chronic headache. The application was designed
to be like a scheduler and implemented as an
i-Appli (Java2ME application, NTT DoCoMo, Inc.,
Japan). All of the data including headache
occurrence, severity, disability, aura, neck and
shoulder symptoms, menstruation, medications on
each day are listed on the data entry canvas. The
patient selects answers from lists and types in
numeric data and comments. Detailed graphic
displays of data are shown on a plot canvas
summarizing year, month, week, or day. In a usage
trial, patients were favorably receptive about
this application and indicated that they wanted
to continue using it. Keywords Headache diary,
medical records, cell phone Introduction A
medical diary is intended as an aid for patients
as a reminder to collect useful data regarding
their chronic diseases, and as a communication
tool between a patient and the specialized care
services (1). Porter et al. (2) developed a
headache chronicle to provide with physicians
insight into the influence of emotional and
environmental factors for the occurrence of
headaches and to study the natural history of
headaches. A diagnostic headache diary is used by
the patient to prospectively record headache
attacks and medicine consumption (3). A
structured migraine diary can be a valuable aid
in improving communication between physicians
and patients regarding migraine disability and
treatment outcomes (4). Russell et al. (5)
reported a diagnostic aura diary for prospective
recordings of migraine with aura. On the other
hand, the Internet is having a radical impact on
healthcare models. Personal digital assistants
(PDAs) and smart phones have become the most
appropriate devices for clinical practices or
studies (6). Although cell phones have not
officially been integrated into hospital life,
they have become an essential communication tool
for modern society (7). Therefore, we developed a
cell phone-based medical recorder for
self-management of chronic diseases.
A
Figure 3 A daily diary. A data entry canvas with
a submenu of headache intensity (middle) with a
submenu of headache pharmaceuticals (right). 
Figure 2 Screen of a calendar canvas.

Figure 1 An overview of the application and a
calendar canvas These data are stored in a
textile format in the memory of the cell phone
(maximum 200 kB). Because the record size of one
schedule is estimated to be about 100 bytes, a
maximum of 2000 records may be stored. An
infrared module sends records in day or month
units to a PC as a textile file. The records on
the PC are automatically tabled and tallied on
Excel with a customized Visual Basic for
Applications (VBA). The application was based
on Java 2 Platform, Micro Edition (J2ME), and
developed with an "i-Appli Development Kit for
DoJa-3.5" on a PC (8). (The Doja is a version of
the Java platform specially tailored to a mobile
environment for NTT cell phones.)
Figure 4 A graph of plot items in the 4th week.
Figure 5 Headache intensity, analgesics and
medications for 1 day.
Figure 6 Headache intensity during 1 week.
Figure 7 Medications for 1 week

• References
• Nappi G, Jensen R, Nappi RE, Sances G, Torelli P,
  Olesen J. Diaries and calendars for migraine. A
  review. Cephalalgia 2006 26905-16.
• Porter D, Leviton A, Slack WV, Graham JR. A
  headache chronicle the daily recording of
  headaches and their correlates. J Chronic Dis
  1981 34481-6.
• Russell MB, Dremstrup Nielsen K, Rasmussen C,
  Schoenen J, Paiva T. Multimedia education in
  headache the European Neurological Network. Eur
  J Neurol 2000 7355-62.
• Baos V, Ester F, Castellanos A, Nocea G, Caloto
  MT, Gerth WC I-Max Study Group. Use of a
  structured migraine diary improves patient and
  physician communication about migraine disability
  and treatment outcomes. Int J Clin Pract 2005
  59281-6.
• Russell MB, Iversen HK, Olesen J. Improved
  description of the migraine aura by a diagnostic
  aura diary. Cephalalgia 1994 14107-17.
• Roelofs J, Peters ML, Patijn J, Schouten EG,
  Vlaeyen JW. Electronic diary assessment of
  pain-related fear, attention to pain, and pain
  intensity in chronic low back pain patients. Pain
  2004 112335-42.
• Aziz O, Sheikeh A, Paraskeva P, Darzi A. Use of
  mobile phones in hospital time to lift the ban?
  Lancet 2003 361788.
• i-Appli Development Tools for DoJa-3.5 Profile.
  http//www.nttdocomo.co.jp/english/service/imode/m
  ake/content/iappli/about/tool_foma2.html
• Ozdemir E, Karacor M. Mobile phone based SCADA
  for industrial automation. ISA Trans 2006
  4567-75.
• Deo SS, Deobagkar DN, Deobagkar DD. Design and
  development of a web-based application for
  diabetes patient data management. Inform Prim
  Care 2005 1335-41.
• Tufano JT, Karras BT. Mobile eHealth
  interventions for obesity a timely opportunity
  to leverage convergence trends. J Med Internet
  Res 2005 7 e58.

Figure 8 A selection canvas of items to be
plotted
Figure 9 A tally on Excel on a PC.
Figure 10 A new questionnaire.
Address for correspondence E-mail
take_at_kitasato-u.ac.jp, Kitasato, Sagamihara, Japan