AHRQ Patient-Reported Outcome Challenge Competition Support

Patient-reported outcomes (PROs) represent a patient’s perspective of their health, quality of life, and functional status. PROs inform health care decisions, shared decision making, and self-management. Most PRO data are collected via pen and paper, making the data difficult for patients and researchers to access and use. While digital tools have been developed to streamline the collection of PROs, they have not been widely adopted due to workflow integration problems and a lack of data standards. Developing an easily adoptable tool that collects and shares standardized data may solve this problem and advance the state of PROs, benefiting health systems, patients, providers, and researchers.

To address this need, the Agency for Healthcare Research and Quality (AHRQ) sponsored the “Step Up App Challenge: Advancing Care Through Patient Self-Assessments.” AHRQ challenged teams to design, develop, and pilot a user-friendly application (app) to simplify the process of collecting, interpreting, aggregating, and sharing PRO data related to physical function outcomes in the ambulatory care setting. Participants were asked to develop apps by employing the HL7 Fast Healthcare Interoperability Resources (FHIR®) Standards in their designs. FHIR standards support integration of health data with different electronic health record (EHR) systems, allowing data exchange across providers and direct use by clinicians and patients.

The specific aims of the project were as follows:

• Support AHRQ in the design, launch, and management of the Step Up App Challenge. 
• Administer and manage the challenge competition by maintaining the challenge web page, branding the challenge, developing challenge marketing and communication materials, and coordinating the challenge activities such as facilitating webinars, managing submissions from challenge entrants, and responding to inquiries. 
• Coordinate and consult with subject matter experts such as physicians, healthcare researchers, and open innovation experts assigned to support the challenge contestants. 
• Test the effectiveness of using a prize challenge mechanism to advance AHRQ’s research initiatives. 
• Distribute payments to awardees. 
• Scan the intellectual property landscape related to digital PRO applications and assist AHRQ in the identification and mitigation of IP issues. 
• Manage the questions and comments of the community of developers and healthcare innovators participating in the challenge. 
• Assist Phase 2 winners to create sustainability plans to further develop and refine their products. 
• Monitor the Phase 3 pilot test and coordinate pilot test logistics with MedStar Health. 

The challenge was conducted in three phases: 1) submission of proposals, 2) software development, and 3) pilot test of the winning app in ambulatory care settings. In Phase 1, over 50 applications were received. Ten finalists were selected to progress to Phase 2 based on originality, feasibility, and executability of their proposed development approach. In Phase 2, three winners were selected. The grand prize winner, Patient-Reported Outcomes Measurement Information System (PROMIS) Reporting Insight System from Minnesota (PRISM^TM), was developed by a multidisciplinary team from the University of Minnesota’s Carlson School of Management, the Institute for Health Informatics, HealthEast Kidney Stone Institute, and PerkHealth, a Minnesota-based startup mobile app development company. PRISM allows patients to report physical function and other PRO measures. Functionality of the app includes score trending, peer group comparisons, and personalized recommendations for followup actions and education materials. Data collected though the app may be integrated with EHRs and made available to providers for clinical care and shared decision making. In Phase 3, PRISM was successfully pilot tested in nine practice settings affiliated with MedStar Health in Washington, DC; Maryland; and Virginia.