Expansion, Implementation, and Evaluation of Electronic Health Record-Integrated Patient-Reported Symptom Screening in a Comprehensive Cancer Center

Patients with cancer have under-recognized physical and psychological symptoms and have supportive care needs that may interfere with their treatment and compromise their quality of life. Cancer care organizations have emphasized the need for symptom assessment and management within quality cancer care delivery. The Commission on Cancer (CoC) requires that accredited centers implement universal psychosocial distress screening and make appropriate referrals to psychosocial services.

The Oncology Symptom Screening Initiative (OSSI) is an electronic health record (EHR)-integrated screening platform that addresses distress, physical symptoms, and practical needs of cancer patients. The OSSI meets the requirements of the CoC standard for psychosocial screening and referral. The Northwestern Medicine Health System in Illinois previously adopted and piloted the OSSI at a single site and made it available to patients to complete via their patient portal. This project will expand, implement, and evaluate the use of the platform across all of Northwestern Medicine’s cancer clinics, making it available to patients both via the patient portal and with in-person visits.

The specific aims of this project are as follows:

• Use the Framework for Spread to guide expansion of the OSSI to reach patients at all Northwestern Medicine cancer clinics and allow for both at-home and in-clinic symptom assessment prior to medical visits. 
• Evaluate the impact of system-wide implementation of the OSSI on patient and system outcomes over 12 months. 
• Identify implementation facilitators and barriers to system-wide expansion of the OSSI. 

The Framework for Spread model considers a variety of factors including leadership and institutional commitment, identification of better ideas, communication, strengthening of the social system, measurement and feedback, and knowledge management. Impact on patient and system outcomes will be evaluated over 12 months and will include a comparison of availability of the OSSI to usual care on EHR-documented health care usage and patient satisfaction. Differences in patient-reported outcomes between those whose OSSI responses trigger clinical alerts and those who do not will be examined. The project team hypothesizes that patients with triggered alerts will utilize more services and will be more satisfied with their care.

This project will inform how to integrate symptom screening into oncology care at large health care systems. It will add to the understanding of the barriers and facilitators to system-wide symptom screening, and its impact on patient- and system-level outcomes.