Designing an Electronic Patient Reported Outcomes Information Infrastructure Supported by the RE-AIM Implementation Framework

ObjectivePatient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical, behavioral, and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) principles. Materials and MethodsWe used Epic Systems as our EHR platform to build the MD Anderson Symptom Index-Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were established and used to design patient-, provider-, and implementing facilitator information tools. ResultsFrom January 2021 to July 2024, our ePRO program has collected 13,156 patient-submitted ePROs on 3,497 unique HN patients, with a 12-month sustained ePRO compliance rate of 82%. We also propose a dynamic clinical implementation-evaluation cycle. This model can be used to continuously (re)define, build, and adapt ePRO information tools for patients, providers, and program facilitators. DiscussionOur ePRO framework has several benefits including integrated clinical data for enhanced decision-making, potential scalability, and use of a common EHR system. Formative (i.e., mid-phase) evaluation and feedback were essential in our program, allowing for timely optimization of ePRO compliance, ePRO usage by clinical staff, and secondary use of high-quality ePRO data. ConclusionIn this article, we provide a valuable roadmap towards developing a comprehensive, EHR-based ePRO information infrastructure simultaneously optimized for clinical utility and implementation evaluation founded on RE-AIM principles.