Integrating with Electronic Health Records: Chapter 13

Questions and Considerations

A. What methods can be used to integrate PROMs with the EHR?

Full integration

• Full integration describes a system wherein PRO collection is contained entirely within the EHR
• Benefits:
  • An integrated system is typically more convenient for patients and providers, as it uses an existing platform to collect and store PROM information alongside other patient data
  • PROMs can be pulled from/pushed to and scored in real-time, and can generate alerts for potentially concerning scores
  • The integrated nature means that PROM completion can benefit from other EHR functionalities, such as patient reminders
  • PRO system data collection can be tied to specific medical events (e.g. automatically timed to procedures or treatments)
  • This approach may reduce redundant completion of PROMs as they are contained within a single record that all providers within a health system can access
  • Scoring and visualization of PROM data can be presented alongside other health information (e.g. vital signs, laboratory tests, clinical notes)
  • It may be more efficient to develop a PRO system within an existing system with an already approved vendor
  • Outcomes can be used to analyze trends across patient populations (e.g. determining how a particular demographic is responding to a pertinent health measure, how effective certain treatments are)
  • For research purposes, PROM data can be easily extracted along with other EHR data
  • Asynchronous collection of PROMs is possible
• Drawbacks:
  • Requires that patients complete the questionnaire via the patient portal or other system tied to the EHR
  • Limits customization options for data collection and results display
  • Any customization requires involvement of EHR and information technology teams
  • The standard PROMs integrated in the EHR system may be more relevant to clinical use rather than for research or administrative goals of PRO systems

Partial integration: PROM collection in stand-alone system

• PROM collection can be conducted in a system that is either bespoke to the healthcare setting or has been purchased from a 3rd party
• These systems can be fully or partially integrated with the EHR
• Many of the benefits and drawbacks of this approach are determined by the specific system being used and its ability to meet the PRO system goals of the intervention
• General benefits:
  • User interface is designed for PROM administration, typically making the program more user friendly for collecting and reporting PROM data
  • Many systems may allow for transfer of PROM data into the EHR, and can pull information from the EHR to inform PRO assessment
  • Advanced and tailored reporting options are usually available
  • PROMs typically will be scored in real-time, and can generate alerts for potentially concerning scores (see Chapter 11, Responding to Issues)
  • Asynchronous collection of PROMs is possible
• General drawbacks:
  • Patients may not be accustomed to entering patient data into systems outside of the EHR patient portal. They may have less trust in non-EHR affiliated systems or be unaware that the PROM collection is linked to their care
  • The use of a stand-alone system may complicate data extraction for research purposes if it requires gathering and merging data from both the stand-alone system and the EHR
  • Additional costs are required to purchase and maintain an outside system
  • Configuration relies on a dedicated technical support team provided by the PRO system, rather than from the health system’s EHR and information technology teams
  • Outside systems may raise data security concerns

Minimal integration

• Paper-based PROM collection can still be integrated into the EHR such as scanning completed PROM forms or entering PROM data into the EHR manually
• Benefits:
  • Paper-based approaches may be more user-friendly to certain patients or within certain clinical settings
  • Fewer upfront costs required
  • Less need for specialized training on how to use an electronic PRO system
• Drawbacks:
  • Higher chance of redundancy in PROM capture
  • Automatic PROM scoring and generation of PROM reports is not available
  • Generally relies more on manual processes and workflows, such as requiring staff to identify eligible patients and track PROM administration over time
  • Manual entry of PROM data by clinical team may add errors