Once ePRO measures have been selected and the workflows designed, it is important to understand how health IT can support health system and project goals regarding how ePROs should integrate with care delivery. The use of IT to deploy PROMs offers an opportunity to provide efficiency in clinical workflow. Throughout the five core workflow activities mapped in the Workflow Design guideline (i.e., deploy, collect, track, review, and document), clinical teams should dedicate time to identifying areas where IT can improve efficiency.
Strategy A
Utilize best practices for the design of ePRO tools
Once you have identified the different ePRO core activities and implications for workflow, we recommend giving thought to the design of the ePRO tool. It is critical to think about many aspects of development, including the different users of the tool, their views within medical records, ways to leverage the existing IT functionalities of your health system, and the methods to identify and address user needs in ePRO tool design.
Utilize established best practices when designing the ePRO tool, particularly those that incorporate principles of user-centered design (see User-Centered Design Recommended Resources in the Tools and Resources section). Conducting usability or formative testing can provide invaluable feedback on the user experience with ePRO tools. Similarly, testing ePRO tools in multiple, diverse environments and across all user views (e.g., provider, clinical staff, patient) can highlight critical barriers to ePRO tool use in clinical workflow. Lastly, engaging in formal pilot testing prior to broader rollout of ePRO tools can identify key training and facilitation considerations that will support adoption and use.
Practice Consideration
Healthcare providers have limited time in which to review ePRO data in the course of patient care, and may have established workflows for how they currently use EHR screens to guide care activities. How ePRO data is presented and formatted can affect a provider’s ability to use ePRO data for clinical decision-making. Refer to our guidelines in the Reporting section for recommendations on ePRO reporting.
It is important to remember that the use of ePROs in practice is an emerging space; it may be helpful to get feedback from other health systems to identify models for ePRO tool design and workflow and lessons learned from the field. Consider reaching out to health systems that are using a similar technology platform as your system for their ePRO implementations to gain insights early in the planning and design project phases. Table 3D provides examples of different functionality approaches that could be considered to address different user needs.
Table 3D: Examples of ePRO functionality approaches
Activity
Examples of Functionality Design
ePRO measure deployed
By placing a manual, stand-alone order
Through the inclusion in an order set for a particular disease-specific pathway
Through automated deployment based on an algorithm that recognizes an upcoming clinic visit (i.e., visit type, patient diagnosis, date of last ePRO completion)
ePRO data collected
Through the patient portal, prior to visit
Through the patient portal, in waiting room
Through the EHR, during visit
With skip logic and/or computer adaptive testing, or without
ePRO response tracked
ePRO completion is integrated into existing, passive reporting tools (i.e., front desk staff can confirm completion at time of check-in)
ePRO completion is monitored through new, tailored reporting tools (i.e., those that can generate customizable lists to support follow-up)
ePRO responses launch active alerts or push notifications (i.e., providers get notified of patient response in real-time)
ePRO score reviewed
Within a reporting tool specific to that ePRO and/or clinical condition
Within a general reporting tool where all patient-generated health data and/or clinical data appear together
ePRO score documented
Within the workflow (i.e., flowsheets, progress notes) for that clinic visit
Within a general registry where ePRO data are stored together
Strategy B
Identify where health IT can improve the efficiency of ePRO workflow
As implementation teams build ePRO tools, they should consider how to use health IT to enable more efficient capture and review of ePRO data.
Figure 3E highlights some potential IT-related functionalities that teams can consider to increase efficiency. Health IT can improve the efficiency of a workflow through functionality that automates steps, curates information to support rapid review, nudges behavior (e.g., alerts or reminders), or allows for user customization. Project teams should work with their IT professionals to understand possible IT functionalities and implications for ePRO workflow.
Figure 3E: Clinical workflow considerations for health IT-enabled ePRO collection and reporting
Strategy C
Ensure health IT tools provide a seamless experience for patients and clinical teams
It is important to recognize that ePROs are one component of the whole care delivery experience. As project teams design ePRO tools and workflows that address stakeholder goals, teams will also need to consider how ePRO tools will interact with other health IT tools used during the care delivery process.
Practice Recommendations
Assess complexities arising from additional IT tools, if available (e.g. scheduling systems, contact systems), on ePRO workflow
Understand the timing and type of health IT systems patients interact with when accessing care
Perform adequate testing of the ePRO tool prior to launch
Test ePRO tools in multiple, diverse environments and across all user views (e.g. provider, clinical staff, patient)
For example, as shown in Figure 3F, a patient might receive an ePRO prior to a visit, along with several other requests for information such as prior medical history, patient-reported data, or insurance information. Ideally, all of these requests should present as one “ask” to the patient. Similarly, a provider may need to review ePRO scores alongside multiple other types of clinical data for that visit.
If ePRO tools require additional logins, require patients or staff to access screens outside the normal workflow, or if ePRO tools generally have a different look and feel than the health IT tools already in use, patients and care teams may be less likely to use them. Lastly, project teams should thoroughly test how ePRO tools interact with other health IT tools in use to support care delivery. Utilizing learnings from the testing and pilot phases can help further clarify the experiences of patients and providers.
Figure 3F: Data flow for patient-reported health data requests
