Leveraging technology key to streamlining patient-reported outcome data collection
Key takeaways:
- A viewpoint paper outlined the benefits of a well-coordinated patient-reported outcomes collection system.
- The authors recommended a text-based system to minimize patient gaps in computer literacy.
Oncology practices must address barriers related to technology and workflow to successfully implement a system to collect patient-reported outcomes, according to a viewpoint paper published in JAMA Oncology.
In the paper, James A. Colbert, MD, MBA, senior vice president of care delivery at Memora Health and hospitalist as Mass General Brigham, and Louis Potters, MD, chair of radiation medicine at Northwell Health, discussed the benefits of collecting patient-related outcomes (PROs) in oncology care. These include reduced patient burden, decreased toxicity and ED use, and potentially improved survival.

However, uptake of PRO collection outside research studies and clinical trials remains low.
In their viewpoint paper, Colbert and Potters noted that successful implementation of PRO collection will require additional education, openness to new technologies and a willingness to integrate new PRO instruments into a practice’s workflow.
“In some cases, there can be a reluctance on the part of clinicians to use new technology. There have been challenges with technologies that have been marketed to health care organizations,” Colbert told Healio. “At the same time, though, we know the status quo is unsustainable and that our workforce is already being stretched to the limit. That’s why we need to figure out how to better leverage technology to streamline the process and create more workforce efficiencies.”
Healio spoke with Colbert about the barriers to PRO collection at the patient and practice levels, as well as his recommendations for successful adoption of a PRO collection system.
Healio: What are the benefits of collecting PROs in oncology practice?
Colbert: PRO data isn’t always systematically collected or documented in a way that makes it easy to longitudinally track.
Instead, what often happens is patients end up feeling sick, and they show up to the emergency room. In some cases, that ED visit was preventable, but it wasn’t flagged early enough because there wasn’t someone collecting PROs. PRO collection would have indicated worsening fatigue, nausea, diarrhea or whatever the symptom was. With PROs, you’re tracking the same symptoms over and over. That allows you to flag a deterioration sooner so you can intervene. Several published studies have shown that when we collect PROs systematically, it can help to reduce ED visits and hospitalizations, and can also help with patient-reported quality of life and even survival.
Healio: What are the barriers to collecting PROs?
Colbert: There are several. One is that clinicians can have a kind of overconfidence in their ability to track how patients are doing. In some cases, there may be a reluctance to rely on a survey or on more formal data collection, because they feel as though they know their patients well. Patients can pick up the phone and call, or send a message through existing channels, so a clinician might think, “Is it really worth implementing?” There is certainly some skepticism at the clinician level.
Another challenge is on the technology side. There are many methods for collecting PRO data. If you are asking patients to fill out a paper form, you need to hire someone in your office to manually input the data from those forms. You can hand out iPads in the clinic and have patients use those to fill out the data, but then you still need a system to track and flag patients with a concerning symptom. You can message or call the patients at home but, again, this requires a staff member. You can send them an email with a link to a questionnaire, but then you need to confirm they are actually opening the email and filling out the questionnaire.
In my experience working with health systems on these issues, we’ve been implementing a text-based system for patients to submit their PRO score. It’s much easier for patients to fill out a questionnaire over text messaging. With this type of system, we’re seeing average data collection rates of 80% to 90%.
Healio: How could text-based PRO collection be implemented more widely?
Colbert: Certain populations and patient groups are very technology literate and can use an app, but the important part is to use an electronic reporting system, such that the data can be collected in an automated way.
Being able to integrate a PRO technology into the workflow is another piece that is extremely important. If we are able to take the data we are collecting from patients and make that information available and actionable for nurses and oncologists in the clinic, then we truly have the ability to impact patient care, and to flag deterioration in clinical symptoms early enough to intervene.
Until now, there has been some struggle with getting PRO technologies integrated into the workflow in a way that is seamless and provides the benefits clinicians and nurses are looking for. If, for example, a nurse is already using an electronic medical record, you need to ensure that PRO data you’re collecting are surfaced through that existing channel in the electronic record itself.
Healio: What advice do you have for practices that want to incorporate PRO collection systems?
Colbert: I would recommend choosing a health technology vendor that has worked with dozens of other health systems and knows how to integrate the data with the electronic medical record. You’re not just integrating the data, you’re also leveraging automation and other AI and machine learning tools to take the human out of the loop as much as possible. You’re surfacing actionable information to clinicians when it’s relevant.
Healio: Is there anything else you’d like to mention?
Colbert: In terms of a text-based PRO collection system, there is an equity component involved. We find that patients who are immigrants and those lower on the economic spectrum may be less engaged and less health literate. They may have trouble with some of the other channels of communication, but we find they are still typically very successful at navigating text messaging, because it’s something that is almost universal.
For more information:
James A. Colbert, MD, MBA, can be reached at jcolbert@mgb.org.