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. 2017 Sep 1;28(9):2305-2311.
doi: 10.1093/annonc/mdx317.

Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment

P Holch  1   2 , L Warrington  2 , L C A Bamforth  2   3 , A Keding  4 , L E Ziegler  5 , K Absolom  2 , C Hector  1 , C Harley  6 , O Johnson  7   8 , G Hall  3 , C Morris  9 , G Velikova  2
Affiliations

Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment

P Holch et al. Ann Oncol. .

Abstract

Background: Significant adverse events (AE) during cancer therapy disrupt treatment and escalate to emergency admissions. Approaches to improve the timeliness and accuracy of AE reporting may improve safety and reduce health service costs. Reporting AE via patient reported outcomes (PROs), can improve clinician-patient communication and making data available to clinicians in 'real-time' using electronic PROs (ePROs) could potentially transform clinical practice by providing easily accessible records to guide treatment decisions. This manuscript describes the development of eRAPID (electronic patient self-Reporting of Adverse-events: Patient Information and aDvice) is a National Institute for Health Research-funded programme, a system for patients to self-report and manage AE online during and after cancer treatment.

Materials and methods: A multidisciplinary team of IT experts, staff and patients developed using agile principles a secure web application interface (QStore) between an existing online questionnaire builder (QTool) displaying real-time ePRO data to clinicians in the electronic patient record at Leeds Teaching Hospitals NHS Trust. Hierarchical algorithms were developed corresponding to Common Terminology Criteria for Adverse Events grading using the QTool question dependency function. Patient advocates (N = 9), patients (N = 13), and staff (N = 19) usability tested the system reporting combinations of AE.

Results: The eRAPID system allows patients to report AE from home on PC, tablet or any web enabled device securely during treatment. The system generates immediate self-management advice for low or moderate AE and for severe AE advice to contact the hospital immediately. Clinicians can view patient AE data in the electronic patient record and receive email notifications when patients report severe AE.

Conclusions: Evaluation of the system in a randomised controlled trial in breast, gynaecological and colorectal cancer patients undergoing systemic therapy is currently underway. To adapt eRAPID for different treatment groups, pilot studies are being undertaken with patients receiving pelvic radiotherapy and upper gastrointestinal surgery. ISRCTN88520246.

Keywords: CTCAE; adverse events; electronic patient records; electronic patient-reported outcomes; integration; patient self-management.

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Figures

Figure 1.
Figure 1.
Flow chart of timelines of the development of the eRAPID system.
Figure 2.
Figure 2.
eRAPID system diagram describing the data flow from public internet to hospital network.
Figure 3.
Figure 3.
Screen shots of the patient view: (A) eRAPID website portal screen, (B) QTool patient welcome page with links to questionnaires, previous responses and feedback, (C) example of the eRAPID symptom report, (D) AE Self-management advice generated from QTool when patient reports mild/moderate symptoms, (E) if patients report low level AE they are directed to the eRAPID website for self-management advice, (F) if patients report a severe AE and if it is a current problem advice (in red) to telephone the hospital is generated, (G) patient view of the tabular summary of AE reported, (H) Patient view of the graphical summary of their responses. Clinician view: (I) graphical display of a one-time completion of PRO results, (J) display of PRO reported results in the EPR in tabular form with severe symptoms indicated in red, (K) graphical display of completion over time with red triangles indicating chemotherapy cycles.
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References

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