Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics

Therese A. Nelson*, Brigitte Anderson, Jiang Bian, Andrew D. Boyd, Shirley V. Burton, Kristina Davis, Yi Guo, Bhrandon A. Harris, Kelly Hynes, Karl M. Kochendorfer, David Liebovitz, Kayla Martin, François Modave, John Moses, Nicholas D. Soulakis, Donald Weinbrenner, Sonya H. White, Nan E. Rothrock, Annette L. Valenta, Justin B. Starren

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Abstract Introduction: Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist. Methods: To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors. Results: Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders. Conclusions: Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.

Original languageEnglish (US)
Pages (from-to)498-507
Number of pages10
JournalJournal of Clinical and Translational Science
Volume4
Issue number6
DOIs
StatePublished - 2020

Funding

This research was supported, in part, by the EHR Access to Seamless Integration of PROMIS (EASI-PRO) grant: U01TR001806, National Center for Advancing Translational Sciences (NCATS)/National Institutes of Health (NIH). (Individual authors funded: BA, JB, ADB, SVB, YG, BAH, KH, KMK, DL, KM, FM, JM, TAN, NER, NDS, JBS, ALV, DW, SHW.) This research was also supported by local Clinical and Translational Science Awards through the National Institutes of Health’s National Center for Advancing Translational Sciences: At the University of Florida, this research was also supported, in part, by internal funding from the Cancer Informatics and eHealth Core as part of the University of Florida Health Cancer Center (JB, YG, KM, FM, DW, SHW).

Keywords

  • electronic health records (EHRs)
  • implementation science
  • Patient reported outcome measures (PROs, PROMs)
  • Patient-Reported Outcomes Measurement Information System (PROMIS)
  • sociotechnical factors
  • university health systems and hospitals

ASJC Scopus subject areas

  • General Medicine

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