Model clinical use of ePRO reports

The value proposition of introducing ePROs to the clinical care process is contingent on not only the knowledge gained from well-designed ePRO reports, but also on the effective use of the reports to bring increased intelligence and wisdom into the care process. Reporting is the result of report design and use depicted in Figure 4S (further discussed at the beginning of this section). Unfortunately, not all organizations or even patient encounters will achieve the full potential of intelligent use of ePROs to increase wisdom in healthcare decision-making and care processes that may be gained. Indeed, the successful use of even the most well-designed ePRO reports is dependent on the characteristics and capacities of individual healthcare organizations and ePRO users.

Figure 4S: Ideal ePRO reporting process (moving from data to wisdom)
Figure showing an ePRO data process moving from Data through Information, Knowledge, and Intelligence to Wisdom

Health systems are well advised to model strategies for ePRO report use to facilitate moving successfully from PRO data collection to ePRO report development to using the reports to improve patient care and shared decision-making efforts (i.e., to move from data to wisdom). Specifically, modeling successful use of ePRO reports can help avoid unintended consequences associated with the introduction of ePROs into the care process as well as enhance the potential positive impact of ePROs. Keys to this guideline and the concept of modeling include:

  • the involvement of stakeholders to inform “use quality” (i.e., meaningful use) of ePROs within each health system and clinical specialty context
  • a user centered perspective of ePRO use
Strategy A
Apply user centered design techniques to model user, context, and workflow

A UCD approach attends to understanding user tasks and process (both current state and future state) and modeling the effective use of an ePRO report. Within the realm of UCD, understanding providers’ mental models (i.e., concepts of ePRO use) is integral to many aspects of developing an effective ePRO report and successful use process. Understanding the provider can help to motivate change, promote compliance, and/or recognize opportune moments where automation can assist.

UCD techniques, such as user personas, are structured ways of typifying a group of users in text and pictorial formats (i.e., conceptually modeling the end users). User personas go well beyond demographics, as they attempt to capture the user’s mental model, comprising their expectations, prior experience, and anticipated behavior. These models attempt to understand the intended users of technology—not just their demographics, but also how they think, feel, and behave, particularly in relation to a new or evolving technology.

Figure 4T presents the persona of a super-typical medical provider in a health system implementing ePROs evolved from our research. Among other things, the persona represented in Figure 4T highlights the providers’ general commitment to patient care as well as the challenges of introducing ePRO reporting into clinical practice, such as constraints on time and imperfect or non-existent measures or benchmarks in some domains. The persona also illustrates some of the motivations for using ePROs that may be shared and leveraged with providers, as appropriate, as well as potential influencers to motivate adoption (e.g., a clinical champion).

Figure 4T: Super-typical medical provider persona, literature-based
Screenshot of a model Medical Provider persona, including their attributes, motivation, influencers, and other relevant factors.

Health systems can adapt the user persona presented in Figure 4T to their context as they consider ePRO reporting change management, report design, process modeling, and training. It would be beneficial for health systems to similarly model patients as users of ePRO systems to facilitate process and report design.

Strategy B
Showcase models of successful ePRO report use discovered in practice

Case studies that model successful ePRO report use can reveal best practices that provide guidance and further inspiration regarding how providers (particularly those new to ePROs) may successfully integrate the use of ePRO reports into their clinical encounter process. Stories and insights from peers and opportunities to shadow providers that regularly and successfully integrate ePRO reports into their workflow may also facilitate trust that the use of ePRO reports can make a difference in practice and provide value.

Quality use of ePROs may be enhanced if those involved with ePRO system design and implementation identify existing success stories within their health system (e.g., through the ePRO catalog process discussed in the Disseminate Learnings guideline or in similar external practices early in the adoption process. ePRO teams can then facilitate structured opportunities, such as webinars, presentations, as well as informal networking to elicit and broadcast model practices and leverage the influence and enthusiasm of clinical champions. Table 4H provides some models for the use of ePROs identified through provider interviews that designers can share and look for in their own organizations.

Table 4H: Models of ePRO report use
Model of ePRO report use As described by providers
Pre-visit planning “Before I go in [to see the patient, I pull the ePRO report] to kind of tailor my discussion of what I’m going to talk about.”
Visual supplement to conversation “I’ll sometimes pull that [ePRO report] up and say, well, I see this is what you said this time. This is what your total was last time. You know, that’s an improvement or this is, you know, still an issue.”
Means to communicate forecasted trajectory “To forecast for them, this is where you can expect to be a year. This is on average where people are already a year following spine surgery. This is, you know, the likelihood that you achieve success pre-operatively.”
Promote interaction “Some patients asked me more about their prognosis and longevity than would have otherwise.”
Clinical decision/course of care “I think it might inform me ... it shows that patients who have had lumpectomies are faring worse in terms of their well-being, than patients having mastectomy reconstruction. That might lead me to counsel people differently when they’re choosing between those two options.”
Tailor focus of patient communication “...when I go in to chat with them, rather than me asking them a lot of questions, a lot of it’s on the questionnaire. So, I could look at the questionnaire, and I can say, hey, I noticed this. This something that you’ve not brought up with [me] in the past. Let’s chat about it.”
Patient counseling tool “I counsel patients that, looking in outcomes data, the people that smoke see improvements but not to the same degree as people who don’t smoke. And so, I use that in my practice now for why you should stop smoking or why I won’t do the surgery until you stop smoking... It’s based on research in using those PROs to say, these are high-risk groups.”

While the general value proposition for accessing ePRO reports is a net benefit, certain clinical situations may not justify sharing an ePRO report with the patient as part of the patient-provider communication process. One possible example is when discussion of the ePRO report may exacerbate patient stress or concern over health progress or status. For further discussion of exception situations where ePROs may not add desired levels of value, see the Integration section, Engage Users guideline.

Quote from Provider Interviews:

“Now if you don’t achieve success postoperatively, I’m not going to pull it [the ePRO report] back up and say, well you’re unfortunately not in a group that achieved success.”

For additional insight on introducing user-centered design best practices (including developing user personas) into ePRO reports, see Recommended Resources related to: