Abstract
Objectives: To report lessons from integrating the methods and perspectives of clinical informatics (CI) and implementation science (IS) in the context of Improving the Management of symPtoms during and following Cancer Treatment (IMPACT) Consortium pragmatic trials. Materials and Methods: IMPACT informaticists, trialists, and implementation scientists met to identify challenges and solutions by examining robust case examples from 3 Research Centers that are deploying systematic symptom assessment and management interventions via electronic health records (EHRs). Investigators discussed data collection and CI challenges, implementation strategies, and lessons learned. Results: CI implementation strategies and EHRs systems were utilized to collect and act upon symptoms and impairments in functioning via electronic patient-reported outcomes (ePRO) captured in ambulatory oncology settings. Limited EHR functionality and data collection capabilities constrained the ability to address IS questions. Collecting ePRO data required significant planning and organizational champions adept at navigating ambiguity. Discussion: Bringing together CI and IS perspectives offers critical opportunities for monitoring and managing cancer symptoms via ePROs. Discussions between CI and IS researchers identified and addressed gaps between applied informatics implementation and theory-based IS trial and evaluation methods. The use of common terminology may foster shared mental models between CI and IS communities to enhance EHR design to more effectively facilitate ePRO implementation and clinical responses. Conclusion: Implementation of ePROs in ambulatory oncology clinics benefits from common understanding of the concepts, lexicon, and incentives between CI implementers and IS researchers to facilitate and measure the results of implementation efforts. Lay Summary When patients are asked how they feel while receiving cancer treatment, their care teams are better able to improve care. Patient-reported outcomes (PROs) measure how well patients feel after treatment. Responding to PROs can improve how well patients live. Implementation science studies evidence-based intervention use in the real world. Clinical informatics uses data and technology to improve care. We share how both can increase PRO collection in diverse settings.
Original language | English (US) |
---|---|
Article number | ooae081 |
Journal | JAMIA Open |
Volume | 7 |
Issue number | 3 |
DOIs | |
State | Published - Oct 1 2024 |
Funding
The Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium is a Cancer Moonshot Research Initiative under the authorization of the 2016 United States 21st Century Cures Act. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers UM1CA233033 (Mayo Clinic, Rochester, MN), UM1CA233035 (Northwestern University, Chicago, IL), UM1CA233080 (Baptist Health System, Memphis, TN; Dana-Farber Cancer Institute, Boston, MA; Dartmouth Hitchcock Medical Center, Lebanon, NH; Lifespan Health System, Providence, RI; Maine Medical Center, Portland, ME; and West Virginia University, Morgantown, WV), and U24CA232980 (RTI International, Research Triangle Park, NC). This work was also supported by the National Institutes of Health, NLM 2 T15 LM 007124-26 postdoctoral training slot to J.L.M. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Our interventions have encountered these challenges during the conduct of the I mproving the M anagement of sym P toms during A nd following C ancer T reatment (IMPACT) Consortium funded by the National Cancer Institute (NCI) under the Cancer Moonshot. IMPACT was designed to support the development, implementation, evaluation, and scaling of EHR-integrated electronic symptom management systems, using IS methods (ie, models/frameworks, study designs, evaluation, implementation strategies). IMPACT deploys interventions that (1) systematically monitor patient-reported symptoms; (2) trigger clinician responses consistent with evidence-based guidelines; and (3) provide support options such as CDS. Approaches are tested via pragmatic randomized trials. The Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium is a Cancer Moonshot Research Initiative under the authorization of the 2016 United States 21st Century Cures Act. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers UM1CA233033 (Mayo Clinic, Rochester, MN), UM1CA233035 (Northwestern University, Chicago, IL), UM1CA233080 (Baptist Health System, Memphis, TN; Dana-Farber Cancer Institute, Boston, MA; Dartmouth Hitchcock Medical Center, Lebanon, NH; Lifespan Health System, Providence, RI; Maine Medical Center, Portland, ME; and West Virginia University, Morgantown, WV), and U24CA232980 (RTI International, Research Triangle Park, NC). This work was also supported by the National Institutes of Health, NLM 2 T15 LM 007124-26 postdoctoral training slot to J.L.M.
Keywords
- cancer
- electronic health information
- implementation science
- medical information
- patient-reported outcomes
- symptom management
ASJC Scopus subject areas
- Health Informatics