Skip to main content

Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record.

Publication ,  Conference
Rosett, HA; Herring, K; Ratliff, W; Koontz, BF; Zafar, Y; LeBlanc, TW
Published in: Journal of Clinical Oncology
November 1, 2019

102 Background: Electronic patient-reported outcome measures (ePROs) offer a new strategy for symptom assessment that can improve quality of life and prolong survival in routine cancer care. However, ePRO systems are often separate from existing electronic medical records (EMRs) and not well integrated into oncology clinics. In this pilot project, we assessed the feasibility and utility of integrating ePROs into our existing EMR and clinical workflows. Methods: The 10-question Edmonton Symptom Assessment Scale (ESAS) was integrated into the Epic EMR at three outpatient clinics in the Duke Cancer Institute. Patients with active MyChart accounts were offered the ESAS survey prior to their visit, via the patient portal. ePRO data were routed to clinicians in tabular and graphical formats. A “SmartPhrase” facilitated easy data integration into clinical notes. We subsequently interviewed clinicians and optimized workflows. Several patient engagement strategies were used, including automated messages, phone call reminders, and electronic tablets, to increase response rate. Results: It was feasible to quickly customize and activate an ePRO in Epic. Over 10 months, 161 patients completed 208 ePRO surveys. Initially, 10-20% of eligible patients completed the MyChart questionnaire. Patient engagement strategies, including phone calls and personalized MyChart messages, had little effect. Ultimately, tablets were introduced in the clinic check-in process, increasing response rates to >90%. Clinicians reported positive regard for the system, and an impact on patient symptom management. Clinician workflow optimization resulted in minimal “clicks” in the EMR, and the SmartPhrase was used in 128 clinical notes. Conclusions: Integration of ePROs into the clinical setting poses three challenges: technical implementation, workflow optimization, and patient engagement. While technical implementation is important, it was the easiest to solve, with patient engagement as the greatest barrier. Clinicians value an integrated ePRO system that automatically routes data to the clinical note. The key to successful ePRO integration is in ease of use for both patients and clinicians.

Duke Scholars

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

November 1, 2019

Volume

37

Issue

31_suppl

Start / End Page

102 / 102

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rosett, H. A., Herring, K., Ratliff, W., Koontz, B. F., Zafar, Y., & LeBlanc, T. W. (2019). Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record. In Journal of Clinical Oncology (Vol. 37, pp. 102–102). American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.2019.37.31_suppl.102
Rosett, Heather A., Kris Herring, William Ratliff, Bridget F. Koontz, Yousuf Zafar, and Thomas William LeBlanc. “Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record.” In Journal of Clinical Oncology, 37:102–102. American Society of Clinical Oncology (ASCO), 2019. https://doi.org/10.1200/jco.2019.37.31_suppl.102.
Rosett HA, Herring K, Ratliff W, Koontz BF, Zafar Y, LeBlanc TW. Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record. In: Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2019. p. 102–102.
Rosett, Heather A., et al. “Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record.Journal of Clinical Oncology, vol. 37, no. 31_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 102–102. Crossref, doi:10.1200/jco.2019.37.31_suppl.102.
Rosett HA, Herring K, Ratliff W, Koontz BF, Zafar Y, LeBlanc TW. Integration of electronic patient-reported outcomes into clinical workflows within the Epic electronic medical record. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2019. p. 102–102.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

November 1, 2019

Volume

37

Issue

31_suppl

Start / End Page

102 / 102

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences