Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;2(1):73-80.
doi: 10.1093/jamiaopen/ooz001. Epub 2019 Jan 30.

Provider perspectives on the integration of patient-reported outcomes in an electronic health record

Renwen Zhang  1 , Eleanor R Burgess  1 , Madhu C Reddy  1 , Nan E Rothrock  2 , Surabhi Bhatt  2 , Luke V Rasmussen  2 , Zeeshan Butt  2 , Justin B Starren  2
Affiliations

Provider perspectives on the integration of patient-reported outcomes in an electronic health record

Renwen Zhang et al. JAMIA Open. 2019 Apr.

Abstract

Objective: Integrating patient-reported outcomes (PROs) into electronic health records (EHRs) can improve patient-provider communication and delivery of care. However, new system implementation in health-care institutions is often accompanied by a change in clinical workflow and organizational culture. This study examines how well an EHR-integrated PRO system fits clinical workflows and individual needs of different provider groups within 2 clinics.

Materials and methods: Northwestern Medicine developed and implemented an EHR-integrated PRO system within the orthopedics and oncology departments. We conducted interviews with 11 providers who had interacted with the system. Through thematic analysis, we synthesized themes regarding provider perspectives on clinical workflow, individual needs, and system features.

Results: Our findings show that EHR-integrated PROs facilitate targeted conversation with patients and automated triage for psychosocial care. However, physicians, psychosocial providers, and medical assistants faced different challenges in their use of the PRO system. Barriers mainly stemmed from a lack of actionable data, workflow disruption, technical issues, and a lack of incentives.

Discussion: This study sheds light on the ecosystem around EHR-integrated PRO systems (such as user needs and organizational factors). We present recommendations to address challenges facing PRO implementation, such as optimizing data collection and auto-referral processes, improving data visualizations, designing effective educational materials, and prioritizing the primary user group.

Conclusion: PRO integration into routine care can be beneficial but also require effective technology design and workflow configuration to reach full potential use. This study provides insights into how patient-generated health data can be better integrated into clinical practice and care delivery processes.

Keywords: clinical workflow; electronic health record; health information technology; patient-reported outcomes; sociotechnical system.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
NMPRO Workflow in the Department of Orthopaedic Surgery’s Joint Replacement Program. NMPRO: Northwestern Medicine Patient Reported Outcomes.
Figure 2.
Figure 2.
NMPRO Workflow in the Robert H. Lurie Comprehensive Cancer Center (RHLCCC). NMPRO: Northwestern Medicine Patient Reported Outcomes; RHLCCC: Robert H. Lurie Comprehensive Cancer Center.
Figure 3.
Figure 3.
The FITT framework: IT adoption depends on the FITT. FITT: fit between individuals, task and technology.
See this image and copyright information in PMC

References

    1. Harle CA, Listhaus A, Covarrubias CM, et al. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report. J Am Med Inform Assoc 2016; 231: 74–9. - PMC - PubMed
    1. Black N. Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167. - PubMed
    1. Fromme EK, Eilers KM, Mori M, Hsieh Y-C, Beer TM.. How accurate is clinician reporting of chemotherapy adverse effects? A comparison with patient-reported symptoms from the Quality-of-Life Questionnaire C30. J Clin Oncol 2004; 2217: 3485–90. - PubMed
    1. Basch E, Jia X, Heller G, et al. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst 2009; 10123: 1624–32. - PMC - PubMed
    1. Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 346: 557–65.. - PMC - PubMed

LinkOut - more resources