An app to measure eczema symptoms using the Patient Oriented Eczema Measure

Patient Oriented Eczema Measure (POEM) is a simple validated symptom measure for atopic eczema which records seven symptoms shown to be important to patients. It is widely used in paper and app form for assessing and tracking eczema activity, both in clinical trials and in normal clinical practice. POEM is recommended by NICE for assessing the severity of atopic dermatitis in NHS practice and has been recommended by the international Harmonising Outcome Measures for Eczema (HOME) group as a core outcome measure for eczema trials and for routine clinical practice.

The app is free to download and use, and the responses are stored entirely within the app itself.

Situation

Simply asking patients “how is your eczema today” does not provide a measurable assessment of the many different ways that eczema symptoms affect a person, such as itching, sleep loss, bleeding and cracking of the skin. Tracking symptoms and measuring outcomes in eczema requires valid, responsive and easy to use tools. A good instrument must be able to pick up differences in disease severity from day to day and week to week from the patient’s perspective and needs to be easily understood and simple to complete. The scores produced should be interpretable and able to be shared easily between patients and health care professionals. If patients are able to record eczema flare-ups they can provide their doctor with a more accurate picture of their eczema severity over time, and use this information to receive the correct treatment.

Aspiration

POEM is a way of engaging patients in a shared care relationship with their health care professional by providing an assessment over time of how their symptoms have altered on a weekly basis. The output (a graph of weekly scores over time) can help patients understand what factors might contribute to their eczema flares and also to monitor response to treatment. The POEM scores can also help health care professionals recognise when a patient’s treatment may need to be escalated.

Solution and impact

POEM was developed at the University of Nottingham in 2004 by asking patients what was most important to them. POEM is composed of seven questions that relate to eczema symptoms that have occurred over the last week: itch, sleep loss, bleeding, weeping, cracking, flaking and dryness. Question responses range from 0 days, 1-2 days, 3-4 days, 5-6 days and every day over the last week. The questions take less than a minute to complete and responses are added to create a score ranging from 0 to 28. It can be completed by the patient or by proxy (such as parents of young children). The app was launched in 2018 and is free for patients, parents and health care professionals to download and use.

Functionality

POEM can be used in paper form (such as in a GP or hospital waiting room prior to seeing the healthcare professional), incorporated into electronic medical records, or completed using the My Eczema Tracker app that is available to download on mobile devices. Using the My Eczema Tracker, POEM can be completed electronically and the score automatically calculated. Additionally, POEM scores are stored, so eczema severity can be tracked over weeks and months and become part of self-management and a more informed conversation with a healthcare professional.

Capabilities

My Eczema Tracker app allows:

• responses to the seven questions making up POEM to be summed up
• weekly POEM scores to be stored for up to a year and plotted on a simple, easy to understand graph
• patients to record other important information such as triggers of eczema flare-ups

Scope

The scope is wide. POEM can be used at home for tracking eczema symptoms and for understanding what might contribute to flares and whether treatment is working adequately.

It can also be used in the GP and hospital clinic to fill in along with a quality of life score before seeing the doctor (this has been done at Nottingham Children’s Hospital for the last 12 years, with use becoming increasingly common in other NHS hospitals around the country). POEM has been translated into 21 languages.

Key figures/quotes 

The Centre for Evidence Based Dermatology has received over 200 international requests to use POEM for clinical trial and clinical practice work since 2018.

Great Ormond Street Hospital and the Royal Devon and Exeter Hospital have incorporated POEM into their electronic medical record systems.

“In Nottingham Children’s Hospital we have found it very valuable over the last 12 years for patients / parents to complete the POEM prior to seeing the dermatology doctor or nurse, to guide the consultation. The POEM app is brilliant as it allows patients to capture their POEM scores electronically between their outpatient appointments.”
Hywel Williams, dermatologist, Nottingham

“I am a paediatric dermatology nurse and have just commenced in post at The Royal Wolverhampton Hospital dermatology dept. I have previously used the POEM assessment tool at Birmingham Children’s Hospital and found it very useful, and would like to implement it with in our dept to improve paediatric services”
Pamela Tomlin, dermatology nurse, Wolverhampton

"The ‘My Eczema Tracker’ app is a really easy way to understand how my eczema has been over a long period of time. It has enabled me to give better information to my doctor about exactly when my eczema has been better or worse. The notes feature is useful to record any changes to my treatment and other useful information. It takes me less than one minute a week to complete."
Tim Burton, adult with eczema, Nottingham

"The great thing about POEM is that it is based on a validated and widely used patient reported outcome measure. It is really simple to fill in on your phone, it is freely available, is without commercial adverts or hidden agenda."
Amanda Roberts, Nottingham Support Group for Carers of Children with Eczema

“Caring for children and their families over many years I have seen how valuable POEM is in clinical practice; it plays a fundamental role in every consultation. NICE also recognises its importance as a simple tool which captures the child’s and/or parents’ or carers’ assessment of severity, itch and sleep loss over the last 7 days."
Sandra Lawton, dermatology nurse, Rotherham

“Eczema comes and goes so much that it can be really useful for people to have a weekly benchmark of how their eczema is doing, to help them decide whether treatments are helping or what might be making it worse. In this situation the POEM app is ideal.”
Miriam Santer, GP, Southampton

Find out more

The POEM website has an overview of POEM, instructions how to use it, a link to download the My Eczema Tracker app, translations and a range of Frequently Asked Questions.

Key contact

Professor Hywel Williams (Professor of Dermato-Epidemiology and Co-Director) and Professor Kim Thomas (Professor of Applied Dermatology Research)

cebd@nottingham.ac.uk