Developing Design Principles to Integrate Patient-Reported Outcomes (PROs) Into Clinical Practice Through Health Information Technology: Data, User Experience, and Workflow Requirements for PRO Dashboards (Washington)

Incorporating Patient-Reported Outcomes (PROs) into clinical assessments and decisionmaking leads to improved patient-provider communication, patient satisfaction, and treatment monitoring. While there are efforts to include PRO data in health information technology (IT) platforms, most health care providers have little experience using PRO displays or incorporating PRO data into health care activities. In 2012, the project team began a process of sharing PRO data with health care providers in clinics across Washington State via the Agency for Healthcare Research and Quality-sponsored Washington State Comparative Effectiveness Research Translation Network (CERTAIN). As part of this effort, a prototype Web-based PRO platform, called PROs in Practice, was developed and pilot tested for collecting and presenting PROs to health care teams. This pilot work uncovered large gaps in evidence about the needs of users in integrating PROs into their practice. The research also revealed that simply adding PRO metrics to structured medical records led to unintended consequences. Health care practitioners and staff raised concerns about the negative impact of using PRO dashboards on clinic workflow, the need to tailor visual displays to the needs of different types of health care team members, and uncertainties related to missing data and validity.

To more effectively integrate PROs into clinical care, a set of evidence-based design principles related to workflow, user-experience, and validity and interpretability specific to PROs is needed. To address this need, this followup project will employ systems engineering methods, human-centered design, and mixed-research methods to develop these principles that will ultimately enable more effective integration of PRO data into patient care activities through health IT.

The specific aims of the project are as follows:

• Evaluate the information needs and health care decisionmaking processes regarding the integration and interpretability of PRO data 
• Specify health care practitioner user requirements for interactive PRO visualizations through human-centered methods
• Characterize clinical workflow needs and impact associated with integration of PROs into clinical care activities through health IT platforms

The project will address fundamental issues for health IT related to PROs and will inform design principles related to workflow, optimal user experience, and data comprehension and interpretation. Since they are being developed in a diverse statewide network, these design principles are likely to be relevant to others across the Nation who are working on effective integration of PROs into clinical care.