Abstract
Collecting patient-reported outcomes (PROs) can improve symptom control and quality of life, enhance doctor-patient communication, and reduce acute care needs for patients with cancer. Digital solutions facilitate PRO collection, but without robust electronic health record (EHR) integration, effective deployment can be hampered by low patient and clinician engagement and high development and deployment costs. The important components of digital PRO platforms have been defined, but procedures for implementing integrated solutions are not readily available. As part of the NCI's IMPACT consortium, six health care systems partnered with Epic to develop an EHR-integrated, PRO-based electronic symptom management program (eSyM) to optimize postoperative recovery and well-being during chemotherapy. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Whenever possible, the system used validated content from the public domain and took advantage of existing EHR capabilities to automate processes. eSyM includes symptom surveys on the basis of the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) plus two global wellness questions; reminders and symptom self-management tip sheets for patients; alerts and symptom reports for clinicians; and population management dashboards. EHR dependencies include a secure Health Insurance Portability and Accountability Act-compliant patient portal; diagnosis, procedure and chemotherapy treatment plan data; registries that identify and track target populations; and the ability to create reminders, alerts, reports, dashboards, and charting shortcuts. eSyM incorporates validated content and leverages existing EHR capabilities. Build challenges include the innate technical limitations of the EHR, the constrained availability of site technical resources, and sites' heterogenous EHR configurations and policies. Integration of PRO-based symptom management programs into the EHR could help overcome adoption barriers, consolidate clinical workflows, and foster scalability and sustainability. We intend to make eSyM available to all Epic users.
Highlights
Recent studies suggest that patientreported outcomes (PROs) help address these shortcomings by enhancing symptom detection and improving symptom control.[9,13]
Studies have found that using telehealth and web-based services to collect electronic PROs from patients with cancer is
The SIMPRO consortium is composed of six US cancer centers (Data Supplement) that were chosen because they had minimal pre-existing electronic PROs (ePROs) experience; were Epic (Verona, WI) electronic health record (EHR) users; and provided care to diverse patient populations including rural, elderly, and vulnerable groups who might benefit from an ePRO solution
Summary
Poor symptom control decreases quality of life, increases the need for emergency care,[1,2,3] and deters patients from receiving life-prolonging therapy.[4,5] For recipients of cancerdirected therapy, suboptimal management of chemotherapy side effects and postoperative symptoms leads to distress, delays recovery, and interferes with timely receipt of comprehensive therapy.[6,7,8] Suboptimal symptom management leads to costly emergency department (ED) visits and hospital admissions, which may be preventable.[9,10,11] Improving symptom management is critical to improving outcomes and reducing costs for patients with cancer. The cancer care delivery system has used a reactive symptom management strategy making it illequipped to anticipate, monitor, and address symptoms before they escalate.[12] Severe symptoms often receive attention only after causing distress and requiring costly interventions; and mild-moderate symptoms can be left unattended even when early interventions could improve quality of life and prevent the development of severe symptoms.
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