Successful integration of an automated patient-reported outcome measure within a hospital electronic patient record

Matthew T Neame; David Reilly; Ajmal Puthiyaveetil; Liza McCann; Kamran Mahmood; Beverley Almeida; Clare E Pain; Victoria Furfie; Andrew G Cleary

doi:10.1093/rap/rkac065

Successful integration of an automated patient-reported outcome measure within a hospital electronic patient record

Rheumatol Adv Pract. 2022 Aug 17;6(3):rkac065. doi: 10.1093/rap/rkac065. eCollection 2022.

Authors

Matthew T Neame^{1

2}, David Reilly¹, Ajmal Puthiyaveetil³, Liza McCann³, Kamran Mahmood³, Beverley Almeida³, Clare E Pain³, Victoria Furfie¹, Andrew G Cleary³

Affiliations

¹ Department of Information Technology, Alder Hey Children's Hospital.
² Department of Women's and Children's Health, University of Liverpool.
³ Department Rheumatology, Alder Hey Children's Hospital, Liverpool, UK.

Abstract

Objectives: The objective of this evaluation was to assess the feasibility of implementing a fully integrated, automated, electronic patient-reported outcome measures (ePROM) system into a hospital electronic patient record (EPR; hospital-based clinical record). Additional objectives included evaluating the effect of the system on patient-reported outcome measures (PROM) completion rates and investigating the acceptability of the ePROM.

Methods: The evaluation was conducted in a rheumatology clinic in a specialist children's hospital in the UK. Paper-based childhood HAQ PROMs were already used in the clinic, and an EPR was the main hospital information system. The technical feasibility of introducing the ePROM technology was assessed using a case study approach; the effect of the system on PROM completion rates was investigated using a before-after design; and acceptability was assessed using semi-structured questionnaires and a focus group.

Results: An automated and integrated ePROM system was implemented successfully in April 2021. After implementation, ∼500 automated SMS text messaging invitations to complete ePROMs were sent to care-givers each month. PROM completion rates increased from 33 of 100 (33%) to 47 of 65 (72%) after the introduction of the ePROM system (χ² = 11.51; P < 0.05). The ePROM system was highly acceptable to patients and clinical staff. Some clinical staff expressed a concern that an electronic system might represent a barrier to care for families with more limited resources.

Conclusion: High levels of automation and integration with existing technology systems seemed to be key contextual factors associated with the successful implementation and adoption of the ePROM intervention in a paediatric rheumatology clinic.

Keywords: Medical informatics; paediatrics; patient-reported outcome measures; quality improvement; rheumatology.