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Integrating with Electronic Health Records: Chapter 13

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In this excerpt (Chapter 13) from the PROTEUS-Practice Guide, you’ll learn several strategies for integrating patient-reported outcomes (PROs) into the electronic health record (EHR).

This webpage contains the entire contents of Chapter 13. You can also download the PROTEUS-Practice Guide by clicking here.

Key Points

  • Full electronic health record (EHR) integration describes a system wherein patient-reported outcome (PRO) collection is contained entirely within the pre-existing EHR
  • Stand-alone collection systems capture patient-reported outcome measures (PROMs) using a bespoke or 3rd party system and can relay this information to the EHR
  • There is a continuum of levels of integrating externally collected data with the EHR, ranging from minimally integrated systems with limited patient-reported outcome (PRO) data uploaded to the health record in a non-modifiable format and more extensively integrated systems where external data are uploaded to the health record as discrete and manipulable values


Integrating PROs in the EHR is an important aspect of making sure that PRO information is well-documented and available to inform clinical care, research, or any other goals of the PRO system. Several strategies are available for integrating PROs into the EHR. One is full PROM integration, wherein the PROM collection and display both take place within the EHR, often via the patient portal.

Another option is stand-alone PROM collection systems, wherein PROMs are collected in a system purchased from a 3rd party or developed specifically for the clinic. These systems communicate bi-directionally with the EHR to a varying extent.

At the most basic level, PROMs can be collected and then entered in the EHR by uploading a scanned copy of the completed PROM or manually entering values.

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

Relevant Primary Resources

The information presented here is an overview of integrating PROs into the EHR. For more detailed information please see the following sources:

Background And Citing The Proteus-Practice Guide

Nothing in this Guide should be construed to represent or warrant that persons using this Guide have complied with all applicable laws and regulations. All individuals and organizations using this template have the responsibility for complying with the applicable laws and regulations or regulatory requirements for the relevant jurisdiction.

Each chapter of the Guide lists the key foundational resources that informed its content. To appropriately recognize the foundational resources, we encourage you to cite both the Guide and the relevant foundational resource(s). Recommended citations are provided here.

Suggested Citation

The PROTEUS Guide to Implementing Patient-reported Outcomes in Clinical Practice
A synthesis of resources. Prepared by Crossnohere N, Brundage M, Snyder C, and the Advisory Group, 2023. Available at:

Further Reading

The Guide draws primarily from the foundational resources cited in each chapter. Please click here to find a selection of other relevant references.

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