The provider perspective: investigating the effect of the Electronic Patient-Reported Outcome (ePRO) mobile application and portal on primary care provider workflow

Abstract

Aim: This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows. Background: The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows. Methods: Over a six-week period interdisciplinary primary care providers (n = 6) and their complex care patients (n = 12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015. Findings: Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.

<p>The Use of Measurement Systems to Support Patient Self-Management of Long-Term Conditions: An Overview of Opportunities and Challenges</p>

“…Healthcare professionals have better insight into the disease activity and identification of issues that may have previously gone undetected 48. For example, healthcare professionals using a mobile-based PROM system for patients with complex needs reported that PROMs provided them with additional information on patients’ wellbeing 52…”

“…In a review of qualitative research on clinicians’ experiences of using PROMs, clinicians thought PROMs can impact on processes of care, such as communication, shared decision-making and care planning 55. Evaluations of PROMs in routine clinical practice have reported improvements in patient-clinician communication in a variety of settings including oncology56 and patients with complex healthcare needs 52…”

“…The system must also be developed in a manner which is conducive to use within clinical settings. Healthcare professionals feel that unhelpful presentation of information may limit how effective measurement systems are in practice 52. Therefore, PROMs data must be presented in a format that is helpful to the clinician, which may include both tabular and graphical formats of PROMs as well as numerical text formats 56…”

“…Measurement systems are only sustainable if healthcare professionals are willing to integrate them into their routine clinical practice 52. Healthcare professionals vary on whether they find PROMs helpful or not 55.…”

The Value of Patient-Reported Outcome (PRO) Data in Digital Healthcare: Using the How-R-you App as a PRO Instrument

“…According to Gallagher et al (2015), patientcenteredness is key to effective treatment of chronic diseases, which entails involving patients more directly in the treatment process. Regularly registering patient data improves the quality of diagnoses and treatment, partly because healthcare professionals are able to adapt plans based on PRO data [6]. PRO data opens up new possibilities, and studies have shown the value of utilizing such data with regard to making early diagnoses and freeing up resources [10].…”