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

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.

Using patient‐reported outcomes (PROs) and patient‐reported outcome measures (PROMs) in routine head and neck cancer care: What do health professionals perceive as barriers and facilitators?

“…The use of third party software for PRO collection, where the existing hospital eMR cannot support PRO collection, necessitates HPs logging into multiple systems and carries the risk of poor care coordination, inefficiencies in activating clinical pathways and referrals and missed opportunities for improved care. [29][30] Whilst it is conceivable and almost intuitive that PROM collection from a patient prior to their clinic appointment may save time for the HP subsequently attending to that patient, time constraints and expectations that PRO-associated tasks will add time and effort undertaken during consultations have, in previous studies, been highlighted as a barrier to PROM collection. 13,17,26,28 We therefore chose to explore this in our study and demonstrated that perceived time constraint appeared to feature as a key barrier in our study as well.…”

Capturing the patient voice: implementing patient-reported outcomes across the health system

“…The three use cases presented provide a nuanced example of how governance structures are needed when PROs are scaled across healthcare organizations in order to enhance efficiencies and promote adoption [43] [25], have emphasized the need for thoughtful measurement selection that complements clinical decision-making. Our findings advance these recommendations by demonstrating the cascading impacts on health system resources and the experiences of patients and care teams when a system-wide measurement strategy is not defined.…”

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

“…Barriers to PRO implementation identified in the literature include a perception among clinicians that full integration is difficult in clinical practice due to workflow disruption [23]. Users also cite lack of actionability and technical challenges [19,23,24]. Barriers to use identified by our participants included language limitations, concerns about the release of data back to patients, and potential disparities among patients in data availability and usage of electronic PROs.…”

“…Like any implementation that alters workflows, PRO implementations encounter many barriers, both real and perceived. Barriers to PRO implementation identified in the literature include a perception among clinicians that full integration is difficult in clinical practice due to workflow disruption [23]. Users also cite lack of actionability and technical challenges [19,23,24].…”