The Problem
In cancer care, patients’ symptoms can go undetected up to half of the time in clinic visits.(1) To fill this gap, quality of life issues and symptoms can be tracked systematically through patient-reported outcomes, whereby patients directly report on their experiences using validated questionnaires. Use of electronic PROs has been shown to improve patient quality of life, reduce trips to the emergency department and lengthen survival.(2) Despite the proven benefits of ePROs, they have not been widely incorporated into routine cancer care through the existing electronic medical records (EMRs).
Our Solution
Impact
The integration of ePROs into outpatient oncology clinics is best broken down into three components for analysis:
- technical implementation,
- patient engagement, and
- workflow optimization.
The technical implementation proceeded more rapidly than initially estimated. The existing ePRO tool in Epic allowed for simple integration of the ESAS questionnaire into the provider and patient-facing systems. Initial patient engagement was low, despite automated MyChart reminders about the ePRO questionnaire. To improve engagement, rapid A/B testing was done to compare phone call reminders against MyChart messages from the clinical team. Both testing strategies increased ePRO survey response rates equally. Despite these reminders, questionnaire response rates remained low and welcome tablets were introduced at the time of check-in to make this system more widely available to patients. The clinical workflow was analyzed during site visits. The key barrier to efficient use of the ePRO in clinics was the time required to file patient data before it could be incorporated in the clinical note. This barrier was resolved in a recent Epic upgrade. In conclusion, this pilot project demonstrated that technical implementation of ePROs within the Epic system is straight-forward technically, but strategies for patient engagement and clinical workflow optimization are required for successful integration.
