Integrate ePRO and clinical data platforms

Integrating ePRO and clinical data platforms (e.g., patient data stored in the EHR) can support the patient care process by centralizing important and relevant information for patient care in a single location to support ease of access. This can be achieved by embedding ePRO reports within the EHR system (e.g., ePRO report access from a tab within the EHR) or presenting clinical data pulled from an EHR as part of an ePRO report.

Integration of multiple forms of patient data can facilitate a holistic picture of patient health to assist decisions and communication related to individual patient care. The holistic picture afforded by integration can facilitate better service, increased robustness, and increased flexibility in using PRO data. Figure 4N provides an example of a dashboard that integrates PRO and clinical data to support a holistic perspective.

Quote from Provider Interviews:

“I think [clinical data] is useful information to get. It provides an important context for some of our patients.”

Figure 4N: Dashboard integrating PRO and clinical data
Graphic showing a dashboard with four panels, Clinical Parameters, Pain Outcomes Improvement, Mean Monthly Pain Days, and Disability Outcomes Improvement

Ideally, the clinical and PRO databases are constructed in a way that provides a functional pathway for compiling or otherwise integrating the data, but this is not always the case. The feasibility of integrating PRO reports and EHR data varies by platform used. A feasible functional pathway is needed to accommodate pulling data from the respective sources for both of the following strategies.

Strategy A
Include EHR data in the ePRO report

Pulling clinical data from other systems (or system modules) into ePRO reports can help to contextualize PRO responses with clinical activities and results (e.g., length of stay, procedure-oriented complications, comorbidity). See the guideline Contextualize Data for more information about supplementing PRO data. Overall, ePRO data visualizations are complemented and contextualized by this information. Presentation and functional means to integrate clinical data within the ePRO report include:

  • providing clinical data next to a graphical PRO representation
  • showing clinical data in an ePRO report annotation
  • providing the additional clinical information via a drop-down arrow (i.e., click to see more details)
  • integrating PRO and clinical data in a dashboard
  • creating a storyboard of the patient’s journey of their health condition as a home page with clinical and PRO highlights. A storyboard is a visual sequence for displaying a story (e.g., a health journey) that can stimulate thought about each step of the patient’s journey and focus attention on key components. This would allow providers to characterize the patient in terms of demographics, condition, treatment and response, and overall progress.

In addition, clinical data may be used as parameters for filtering PRO data to include only relevant subsets of information in requested reports, particularly for comparative PRO reports (see the Filter Data guideline regarding PRO filters and the Comparative Information guideline for comparative ePRO reports). One of the prevailing challenges in executing this strategy is determining what clinical and PRO data is most useful to coexist in a limited screen space. There is value in providing data from both sources in one view—it limits the need for providers to toggle between two screens to access needed information (e.g., by overlaying clinical and PRO data in a single ePRO report). However, this value may be undercut if the volume of data displayed becomes a hindrance to comprehension. A balance is needed regarding the amount of clinical data provided with PROs to avoid information overload and visual clutter.

Quotes from Provider Interviews:

“I look back and I say, ‘what was it that we changed that caused this to happen’ and I have to go digging to try and figure out what it was. If there was a way of saying there was an intervention and actually saying what that intervention was, and it was something that actually the system put into the tool for me so that I didn't have to make that annotation that would be nice.”

“I think it helps whenever clinicians don't have to go to two different programs or applications. If it’s right there with the rest of the labs or vital signs, it’s a lot easier to click on it, as opposed to opening it on a new application and remembering to do so.”

Strategy B
Embed ePRO reports within the EHR

Seamlessly embedding ePRO reports into the EHR can help to support a general clinical culture that recognizes the value of ePROs and ultimately integrates ePROs into standard clinical workflows. An organization that wants to integrate ePROs into existing clinical workflows may include ePRO reports, for example on an EHR flow sheet alongside EHR data. This presentation may include the use of clinical decision support queues related to ePRO scores (Figure 4O).

Figure 4O: Flow sheet in EHR related to PRO
Table showing actions to take based on PHQ score: 0 to 9, no action required; 10 to 14, items to address; greater than or equal to 15, address all items.

Some of the prevailing challenges for operationalizing these strategies are listed below, along with tactics to consider in addressing these challenges:

Challenges and Tactics Integrate Clinical Data


  • Cost: Integrating ePRO with the EHR can be time consuming and costly.
  • Technical capacity: Not all EHRs have PRO modules or can easily integrate PRO data from outside systems.
  • Free text difficulty: Text fields are more difficult to integrate into ePRO reports than numeric or categorical data.


  • Review your EHR’s capacity to integrate.
  • Calculate if the IT time and resources available align with the benefits of integration.
  • Provide a means for scanning or manually inputting the most important PRO data in the EHR.
  • Use drop-down lists, where appropriate, in PRO and EHR systems rather than free text fields.