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

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, similar to 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 (chi(2) = 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. Lay Summary What does this mean for patients? We conducted this study to find out whether it would be practical to use an electronic version of a health questionnaire to collect information about young people's symptoms and well-being ahead of planned, hospital rheumatology clinics. The aim was to send and upload the completed questionnaires into the patients' electronic health records using a new automated system. We wanted to find out whether this would increase the frequency with which the questionnaire information was recorded in the health records and to understand whether patients and health-care professionals would find the electronic system acceptable to use. The system was set up successfully and increased the frequency with which the questionnaire results were recorded in patients' health records from 33% to 72%. The study also identified that patients, their families and health-care professionals generally found the system easy to access and to use. Overall, we think this study highlights that there is potential to use systems like this to improve the quality of information that hospital systems can collect from their patients. This can lead to better understanding of symptoms, contributing to the best possible care.