Implementing electronic health record–integrated screening of patient-reported symptoms and supportive care needs in a comprehensive cancer center

Sofia F. Garcia*, Katy Wortman, David Cella, Lynne I. Wagner, Michael Bass, Sheetal Kircher, Timothy Pearman, Frank J. Penedo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background: Oncology practice can be enhanced by the integration of the assessment of patient-reported symptoms and concerns into the electronic health record (EHR) and clinical workflows. Methods: Adult oncology outpatients (n = 6825) received 38,422 invitations to complete assessments through the EHR patient portal. Patient-Reported Outcomes Measurement Information System computer adaptive tests were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial, nutritional, and informational needs. In real time, assessment results were populated in the EHR, and clinicians were notified of elevated symptoms and needs. Results: In all, 3521 patients (51.6%) completed 8162 assessments; approximately 55% of the responding patients completed 2 or more within 32 months. Fatigue, pain, anxiety, and depression scores were comparable to those of the general population (approximately 5% of assessments triggered clinical alerts across those domains); mean scores indicated a lower level of physical function (with severe scores prompting alerts in nearly 5% of assessments). More than half of assessments triggered an alert based on patient endorsement of supportive care needs, with the majority of those being nutritional (41.82% of assessments). Patient endorsement of supportive care needs was associated with significantly higher anxiety, depression, fatigue, and pain interference scores and lower physical function scores. Patients who triggered clinical alerts tended to be younger and more recently diagnosed, to have greater comorbidities, and to be a racial/ethnic minority. Patients who triggered clinical alerts had more health care service encounters in the ensuing month. Conclusions: EHR integration facilitated the assessment and reporting of patient-reported symptoms and needs within routine oncology outpatient care.

Original languageEnglish (US)
Pages (from-to)4059-4068
Number of pages10
Issue number22
StatePublished - Nov 15 2019


  • ehealth
  • electronic health records
  • outcomes measurement
  • patient-reported outcomes
  • psychosocial care
  • symptom management

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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