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.
health. Frequently, individuals use a variety-or an ecosystem [1]-of technologies to share their experiences, connect with others, and manage aspects of care.In recent years, digital resources to support mental health have proliferated. While there have been some approaches to categorize and characterize resources, such as One Mind PsyberGuide (https:// onemindpsyberguide.org/) for mobile apps, we have limited understanding of the breadth of tools, services, and other approaches for mental health support and the best practices of their use. While HCI researchers have examined the role(s) of technologies for individuals living with mental illness, much of this Globally, the World Health Organization (WHO) estimates that 450 million individuals suffer from mental and neurological disorders. In the U.S. alone, in a given year, 44 million adults experience mental illness, including anxiety, depression, eating disorders, and schizophrenia. Individuals living with mental illness navigate disclosures of their experience and self-management as well as interactions with clinical care as part of their everyday lives. Activities to manage mental health needs may be broad reaching and dispersed, including in-person conversations, therapy, and interactions online and through mobile applications. A growing body of research in HCI suggests that people do not rely on only one resource or G Insights → Understanding tools used in technology ecosystems can lead to mental health resources that leverage existing opportunities rather than create new demands. → Mixed method, multidisciplinary approaches can capture the complexity of technology ecosystems. → Foregrounding ethical considerations highlights the needs of people with mental illness including potential and inadvertent consequences of systems designed with good intentions.
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