Abstract
Background Patient-reported outcome (PRO) measures have become an essential component of quality measurement, quality improvement, and capturing the voice of the patient in clinical care. In 2004, the National Institutes of Health endorsed the importance of PROs by initiating the Patient-Reported Outcomes Measurement Information System (PROMIS), which leverages computer-adaptive tests (CATs) to reduce patient burden while maintaining measurement precision. Historically, PROMIS CATs have been used in a large number of research studies outside the electronic health record (EHR), but growing demand for clinical use of PROs requires creative information technology solutions for integration into the EHR. Objectives This paper describes the introduction of PROMIS CATs into the Epic Systems EHR at a large academic medical center using a tight integration; we describe the process of creating a secure, automatic connection between the application programming interface (API) which scores and selects CAT items and Epic. Methods The overarching strategy was to make CATs appear indistinguishable from conventional measures to clinical users, patients, and the EHR software itself. We implemented CATs in Epic without compromising patient data security by creating custom middleware software within the organization's existing middleware framework. This software communicated between the Assessment Center API for item selection and scoring and Epic for item presentation and results. The middleware software seamlessly administered CATs alongside fixed-length, conventional PROs while maintaining the display characteristics and functions of other Epic measures, including automatic display of PROMIS scores in the patient's chart. Pilot implementation revealed differing workflows for clinicians using the software. Results The middleware software was adopted in 27 clinics across the hospital system. In the first 2 years of hospital-wide implementation, 793 providers collected 70,446 PROs from patients using this system. Conclusion This project demonstrated the importance of regular communication across interdisciplinary teams in the design and development of clinical software. It also demonstrated that implementation relies on buy-in from clinical partners as they integrate new tools into their existing clinical workflow.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 145-154 |
| Number of pages | 10 |
| Journal | Applied Clinical Informatics |
| Volume | 15 |
| Issue number | 1 |
| DOIs | |
| State | Published - Aug 25 2023 |
Funding
The HealthMeasures/PROMIS team which has supported K.N., N.R., M.B., & M.L is funded in part by Assessment Center API licensing fees. D.C. served as President of the PROMIS Health Organization in a non-compensated role. Z.B. is an employee of Phreesia, Inc. and receives equity in the company. Funding The initial development of NMPRO was funded by the Vice Dean for Scientific Affairs and Graduate Education at the Feinberg School of Medicine. NMPRO and J.S. were funded by UL1TR000150 and UL1TR001422 from the National Center for Advancing Translational Science (NCATS). Evaluation and lessons learned development was funded by U01TR001806 from NCATS. K.N. was supported by NIH/NCI training grant CA193193. In kind implementation support was provided by Northwestern Memorial HealthCare. Acknowledgments We thank Northwestern Medicine Analytics, Quality, and Operations for providing updated usage statistics on NMPRO.
Keywords
- IT design and development methodologies
- clinical informatics
- electronic health records
- health informatics interoperability
- patient-reported outcome measures
ASJC Scopus subject areas
- Health Informatics
- Computer Science Applications
- Health Information Management