Implementing an Application Programming Interface for PROMIS Measures at Three Medical Centers

Abstract

Background There is an increasing body of literature advocating for the collection of patient-reported outcomes (PROs) in clinical care. Unfortunately, there are many barriers to integrating PRO measures, particularly computer adaptive tests (CATs), within electronic health records (EHRs), thereby limiting access to advances in PRO measures in clinical care settings. Objective To address this obstacle, we created and evaluated a software integration of an Application Programming Interface (API) service for administering and scoring Patient-Reported Outcomes Measurement Information System (PROMIS) measures with the EHR system. Methods We created a RESTful API and evaluated the technical feasibility and impact on clinical workflow at three academic medical centers. Results Collaborative teams (i.e., clinical, information technology [IT] and administrative staff) performed these integration efforts addressing issues such as software integration as well as impact on clinical workflow. All centers considered their implementation successful based on the high rate of completed PROMIS assessments (between January 2016 and January 2021) and minimal workflow disruptions. Conclusion These case studies demonstrate not only the feasibility but also the pathway for the integration of PROMIS CATs into the EHR and routine clinical care. All sites utilized diverse teams with support and commitment from institutional leadership, initial implementation in a single clinic, a process for monitoring and optimization, and use of custom software to minimize staff burden and error.

Seamless Integration of Computer-Adaptive Patient Reported Outcomes into an Electronic Health Record

“…Other hospital systems have implemented PROMIS CATs in different EHRs through independent software that relies on the AC-API. 13 25 …”

“…This app makes PROMIS CATs accessible to any hospital using Epic without the need for an existing middleware framework as was required by NMPRO. Other hospital systems have implemented PROMIS CATs in different EHRs through independent software that relies on the AC-API 13,25 .…”

“…To address the first hurdle, the Assessment Center Application Programming Interface (AC-API) was created to support the administration of individual CATs without requiring use of Assessment Center study management functions. 4,11,13 Northwestern Medicine Patient-Reported Outcomes Middleware…”

“…Other hospital systems have implemented PROMIS CATs in different EHRs through independent software that relies on the AC-API. 13,25 Lessons Learned Two specific themes emerged as lessons learned over the course of NMPRO: first, communication within the interdisciplinary team was essential to the project's success, and second, the implementation of the project into realworld clinical use required immense effort. Finally, we touch on a few future directions for this work.…”

Engaging primary care clinicians in the selection of implementation strategies for toddler social-emotional health promotion in community health centers.

“…One addition to the adapted protocol was usability testing of the MAPS-EASI screener, conducted during individual interviews. The MAPS-EASI screener was modeled on the well-established PROMIS measures, which have undergone extensive usability testing during development and electronic health record (EHR) integration (Bass et al, 2021). The addition of usability testing in this work was informative because the MAPS-EASI had not yet been electronically administered by pediatric clinicians who treat the populations intended to use the screener.…”