Align goals for ePRO use with IT infrastructure

Implementing ePROs can require complex functionality related to the deployment, collection, tracking, reporting, and documentation of PROMs.

Traditionally, efforts made by health systems to develop new digital tools (e.g., new electronic health record [EHR] functionality) begin with the process of gathering functional requirements, which describe how the tool will be used in practice and the technical specifications necessary to support the desired functions and IT standards. As an important planning step, health systems benefit from clarifying their requirements for ePRO tools and how requirements can guide their overall strategy for ePRO projects and system maintenance.

Stakeholder input (please see ePRO Stakeholders in the Introduction section) can inform functional requirements to guide the selection and/or development of ePRO tools. Please see ePRO requirements assessment for system design in the Tools and Resources section. Defining the functional requirements can illuminate limitations or barriers that need to be addressed for system-wide ePRO implementation.

Strategy A
Identify ePRO functional requirements to support system-wide implementation

Each health system will need to consider technical specifications and approaches for ePROs, based on vendors used, current data infrastructure supported, and the health system’s vision for how ePROs will be integrated across the system. The Leverage HIT guideline in the Integration section provides examples of different IT approaches that could be utilized for each of the core ePRO functions. An important role for ePRO governance is helping to gather “ideal” requirements for ePROs before and during the planning phase. This supports efforts to:

  • understand what the technical capability needs may be
  • select implementation approaches that will support identified needs across the system
  • align with resource availability

Needs assessment through stakeholder engagement (please see Goal Alignment guideline) can determine preferences for the design and use of ePRO tools and develop an understanding of the capabilities and limitations of available technical approaches.

Strategy B
Specify the approach for using health IT infrastructure to support ePRO use

While health IT resources facilitate ePRO implementation, the fundamental strategy for how technology will support ePRO use may vary from one health system to another. Integration into clinical workflows may include:

  • standalone applications or platforms
  • PROM questionnaires incorporated in the EHR along with the patient’s other health information
  • a hybrid approach wherein external platforms and/or apps are used with programming to support integration into EHR workflows

Practice Consideration

The resources needed for ePROs may involve more than just the designated ePRO platform. Additional resources such as tablets or kiosks, strong Wi-Fi connections in waiting rooms, or even additional staff, may be needed for clinical teams to be successful.

The strategy selected (please see ePRO Integration in the Introduction section) should be informed by health system leadership and take into account available IT resources, IT governance, and future changes in technological capabilities. Whenever possible, implementation teams should conduct feasibility testing and seek mentorship from external health systems using ePROs to support the identification of best practices.


Strategy C
Establish standards for how ePRO functionality is designed and used in practice

Health systems benefit from establishing IT standards and best practices for ePRO tool design and use (e.g., common data standards, centralized reporting tools). Once health systems have determined their system-wide approach to ePRO tools (i.e., EHR, third-party vendor, hybrid approach), there are a variety of more nuanced decisions to consider for each aspect of ePRO functionality. Over time, some key best practices may emerge that will benefit from formal dissemination (e.g., how to automate health risk screening tools in the primary care population).

Health systems may want to consider opportunities to recommend IT approaches to deploying ePROs that:

  • most effectively meet the intended goals for functionality
  • are the most sustainable to maintain across multiple PRO deployments
  • if possible, conserve clinical, administrative, and technical resources and mitigate the burden on end-users

Establishing IT standards for ePROs may be one way to ensure learnings about best practices and recommendations are disseminated across the system. Spending time to identify sustainable project strategies and disseminating these best practices up front can greatly reduce the need for rework after ePRO tools are put into practice.