Electronic patient-reported outcome systems improves outpatient workflow

The use of electronic patient-reported outcome systems, or ePROs, reduced outpatient wait times without worsening outcomes or satisfaction with care, according to a review in the The Royal Society of Medicine Journals.

“Successful integration of ePROs into existing health systems and the effective utilization of the data is crucial,” Olalekan Lee Aiyegbusi, MBChB, PhD, an associate professor at the University of Birmingham’s Centre for Patient-Reported Outcome Research, told Healio. “Evidence suggests that when ePRO results are used regularly and actively by clinicians to determine the focus and guide clinical consultations, they could potentially enhance workflow efficiency and save time.”

According to Aiyegbusi and colleagues, patient-reported outcomes are defined as reports of condition status that come from directly from the patient, without interpretation by anyone else. With increased physician interest in patient-reported outcomes, as well as technological advances within the practice setting, “various studies have demonstrated that the collection of ePROs in routine clinical practice is both acceptable and feasible, with patients increasingly expressing a preference for an electronic mode of administration.”

To provide a summary of potential ePRO benefits and obstacles, the researchers examined 18 articles focusing on the use of ePRO solutions in outpatient settings.

Overall, the researchers identified several notable benefits, particularly with regard to outpatient times and management, physician-patient communication and physician interventions.

“When ePROs were administered remotely, it facilitated the triaging of patients. Symptom support was provided to clinically stable patients who did not require outpatient appointments, while patients who needed to be seen in person were given appointments and seen more quickly,” the researchers wrote. “This led to significant reductions in outpatient appointments and the timely provision of interventions in several clinical specialties.”

Specific outcomes that were improved with ePRO use included:

• fewer in-person visits for problematic symptoms in patients with lung cancer;
• reduced outpatient visits and hospitalizations in patients with inflammatory bowel disease; and
• decreased need for a follow-up visit following breast reconstruction surgery.

The use of ePROs also contributed to a 7.4% lower rate of treatment discontinuation in patients receiving cancer immunotherapy, according to the researchers.

Aiyegbusi said that clinicians who were interviewed in one of the articles found ePROs “to be ‘beneficial rather than burdensome.’”

“There is evidence that PRO collection may enhance satisfaction among clinicians who are experienced in the use of PROs for the routine management of patients,” he said.

In addition, the researchers wrote that “clinicians reported that ePRO data facilitated their understanding of patients’ general health status and symptoms, identification of low-grade and high-grade symptomatic adverse events, accurate documentation of patients’ symptoms and improved patient adherence to treatment.”

However, they also highlighted multiple barriers for ePROs, such low levels of computer and health literacy within certain populations.

“Predominantly Black and non-English-speaking populations from socioeconomically disadvantaged backgrounds may be less likely to be considered for ePRO-based follow-up,” they wrote. “Therefore, the successful implementation of ePROs in clinical care could exacerbate health disparities if the advantages of ePRO are not also available to already disadvantaged patients.”

Aiyegbusi said that “further research is required to evaluate the impacts of ePRO systems on patient safety, patient and clinician satisfaction, impact on clinical workflow and to establish if they promote cost-effective delivery of care.”