Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics

Abstract

Introduction: Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist. Methods: To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors. Results: Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders. Conclusions: Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.

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

“…This approach to implementation supports previously published research documenting the importance of pre-implementation planning, addressing the impact on workflow, conducting workforce training, utilizing relevant measures, and inclusion of diverse teams with clinician champions. [19][20][21][22]…”

The need for a measurement-based care professional practice guideline.

“…Notably, however, there is growing recognition that implementation science methods and principles can begin to address some of these key barriers (see Childs & Connors, 2021; Lewis et al, 2019). While still nascent, the growing field of implementation science and increasing literature on the integration of routine, standardized patient assessment in other specialties offer a starting point for effective implementation planning (Chan et al, 2019; Gerhardt et al, 2018; Nelson et al, 2020; Sisodia et al, 2020). We expect that a PPG will prompt more attention to the dissemination and implementation of MBC, including collaborative efforts to develop strategies to mitigate patient, provider, and system-level barriers.…”

Integrating Patient‐Reported Outcomes Within Routine Hepatology Care: A Prompt to Action

“…EASI PRO (EHR Access to Seamless Integration of PROMIS) is a multisite consortium that has developed structures and processes to integrate PROMIS CAT tools within Cerner and Epic (the two largest EHRs in the United States). ( 18 ) A PRO planning guide, a decision log, and an implementation plan have been developed and made available in the public domain for immediate use. If EASI PRO is validated to positively impact patient care, similar approaches can be implemented for CLD patients using validated PROs within EHRs.…”