Coordinate Across Healthcare System

Poorly coordinated implementation can result in increased patient burden.

Coordinate Assessment Content

It is helpful for a healthcare system via a governance structure to establish an approach for selecting patient-reported outcome measures across clinics. Goals can include:

  • Reducing redundant assessments through use of universal measures such as PROMIS and/or making measure results easily visible to all providers.
  • Limiting assessment frequency at a system-level to reduce patient burden. For example, if a patient has two appointments in one week, the patient should not be prompted to complete the same measure each time. Results from the first assessment should be visible to providers at the second appointment.
  • Limiting workflow disruption through having an identified assessment length limit (e.g., 25 questions). 
  • Ensure selected measures matche clinic and healthcare system’s aims. For example, if measures are to inform individual patient, guard against inclusion of measures to be utilized for research purposes.

Example A: A healthcare system selected a core battery of measures for universal aspects of health (e.g., pain) to be assessed prior to each appointment. A clinic can supplement the assessment with additional measures totaling less than 20 questions. For example, Urology included a measure of urinary symptoms for all patients and erectile dysfunction for male patients in addition to the standard battery of pain, physical function, depression, and anxiety.

Example B: Any clinic can identify aspects of self-reported health that inform individual patient care and nominate measures to quantify those domains. No core battery is utilized. However, the healthcare system strongly encourages use of universal measures when possible to reduce patient burden, facilitate use across clinics, and create expanded research opportunities. This reduces the risk of having multiple measures of the same domain (e.g., fatigue). For example, orthopedic surgery assesses pain and physical function. Nephrology uses the same physical function measure as well as measures of fatigue and sleep disturbance.

Governance

When implementation of patient-reported outcomes is conducted across multiple clinics or an entire health system, a governance structure is needed. The ePROs in Clinical Care site, funded by the Agency for Healthcare Research and Quality (AHRQ), identifies multiple tasks for a governing body including:

  • Aligning patient-reported outcome assessment aims with the healthcare system’s goals
  • Identifying how IT infrastructure will be utilized
  • Creating a process for evaluation, coordination, and prioritization of implementation for specific clinics
  • Defining and monitoring implementation metrics

This site provides downloadable tools such as:

  • Sample governance charter
  • Project intake checklist
  • Implementation planning checklist
  • Sample monitoring plan

Find these and more under Tools and Resources. Learn more>>

PCORI supported the creation of the Users’ Guide to Integrating Patient-Reported Outcomes in Electronic Health Records in 2017. It identifies multiple approaches to governance including:

  • Distributed governance
  • Centralized Governance
  • Hybrid

It also identifies options for membership including:

  • Pre-existing governance body for electronic health record
  • Patient representatives
  • Broad group of stakeholders

A PDF of the presentation “How will the PRO-EHR system be governed?” is also available. Learn more>>