Advancing the Collection and Use of Patient-Reported Outcomes Through Health Information Technology (Maryland)

Project Final Report (PDF, 1.64 MB)

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Advancing the Collection and Use of Patient-Reported Outcomes through Health Information Technology - Final Report

Citation:
MedStar. Advancing the Collection and Use of Patient-Reported Outcomes through Health Information Technology - Final Report. Prepared under Contract No. 233-2015-00022I-4. AHRQ Publication No. 20-0044. Rockville, MD: Agency for Healthcare Research and Quality; June 2020. (PDF, 1.64 MB)
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The coordination of human and technical processes using a systems approach is crucial to ensure the successful use of PRO data.

Project Details - Ended

Summary:

The patient’s perspective is central to healthcare decisions around prevention, diagnosis, treatment, and long-term care. Patient-reported outcomes (PROs) critically inform patient-centered outcomes research and support clinical management of individuals, shared decision making, patient self-management support, goal setting, and goal attainment. Standardized collection of PROs through patient electronic assessment and subsequent integration into electronic health records (EHRs) has the potential to improve system-wide comparisons of health outcomes, population health monitoring, and new opportunities to evaluate the effectiveness of alternative interventions and treatments. Despite their importance to patient care, PROs are not collected routinely. One promising solution to increasing use of PROs may be via mobile applications (apps) developed with standards, which could allow for smoother integration of that data into EHRs or other health information technology (IT) systems. This research, led by MedStar Health, supported the development of electronic applications that enable the collection of diverse PRO measures in a standardized manner across health providers and systems to enable broader data sharing for clinical care and research. In addition, the team pilot tested the winning app of the Agency for Healthcare Research and Quality’s (AHRQ's) 2018 Step Up App Challenge competition, the PRISM (PROMIS Reporting and Insight System from Minnesota) app. This app allows patients to complete PROMIS physical function measures and other PROMIS measures. PROMIS measures are a set of person-centered measures that evaluate and monitor physical, mental, and social health. Finally, the researchers modified an existing app by incorporating Fast Healthcare Interoperability Resources (FHIR) technical specifications and pilot tested the modified app to collect and integrate standardized PRO physical function data into different EHRs. The modified app and the PRISM app were pilot tested in a total of 18 primary and specialty care practices across MedStar and Capital Area Primary Care Research Network (CAPRICORN), with 10 patients targeted to enroll and use the app at each site. Participating sites were of various size, geographic locations, with varied workflows, and using three different EHRs.

The specific aims of the research were as follows:

  • Collect and report stakeholder input regarding the functionality and usability requirements for the development of user-friendly applications that collect standardized PRO data and factors affecting their implementation. 
  • Design and execute a plan for pilot testing the winning app from AHRQ's Step Up Challenge competition in a mix of ambulatory care settings. 
  • Modify an existing PRO data collection app by incorporating FHIR technical specifications and pilot test the modified app in a mix of ambulatory care settings. 

The project revealed several lessons learned: 1) mobile apps are amenable for patients taking surveys, 2) technical assistance or additional staffing is a critical factor to ensure adoption for many practices, 3) no amount of planning can replace testing in the ‘real world’ -- which is critical to successful local implementation, 4) an abstraction layer between the app and the EHR is critical to the success of integrating PRO data into the EHR, and 5) institutional policies impact success.

This project was an important step toward testing the application of FHIR technical specifications in PRO data collection and integration. The findings showed various factors critical to the successful adoption, potential scaling, and sustained use of this technology in ambulatory care settings.