Health Systems Study EHR-Based Symptom Management Tool

Six U.S. healthcare systems are beginning work on a research project to integrate patient-reported outcomes (PROs) into routine oncology practice as part of the National Institute of Health Beau Biden Cancer Moonshot Initiative.

 The aim of the Symptom Management Implementation of Patient Reported Outcomes in Oncology Research Center (SIMPRO, for short) is to assess how real-time feedback from patients can help providers improve symptom management and reduce the need for repeat hospital visits.

 Starting Oct. 25, the West Virginia University (WVU) Cancer Institute will enroll its first patients in the trial use of an app to answer survey questions that will be incorporated into their MyWVUChart EHR account. They will be asked to complete surveys two or three times per week for the first month after surgery, then fill them out weekly for a total of five months.

There will be two groups followed, one in medical oncology and one open to patients who have undergone thoracic, gynecologic or gastrointestinal surgery.

 Besides WVU, the other five health systems participating are Baptist Memorial Hospital, Dana-Farber Cancer Institute, Dartmouth-Hitchcock Cancer Center, Lifespan Cancer Center and Maine Medical Center. The vendor partner on the project is Epic Systems, which built a platform within MyChart. The app is called eSym for electronic symptom management.

Hannah Hazard-Jenkins, M.D., breast surgical oncologist at the WVU Cancer Institute and co-principal investigator on the project, said the initial iterations of patient-reported outcomes came from clinical trials, and the paper forms patients fill out. “The challenge is integration into the electronic medical record — not only integration, but also minimizing disruption in clinical work flow,” she said. “The data says for every hour you spend in clinic you spend another 30 to 45 minutes doing paperwork or clicking in front of a computer. We have to find a way to integrate a PRO system in a way that minimizes disruption. This system is built directly into Epic, so as soon as the patient hits the submit button, it goes directly to the patient’s chart, and is directly accessible by the provider.”

 Once they answer the survey questions, the program gives the patients a composite score. Scores of zero, one or two are considered mild to moderate symptoms. “Those get messages back that says here is a link to resources to help manage your symptoms,” Hazard-Jenkins said. If they have a composite score of 3, they get a message that their symptoms are severe, and that they should call their doctor. In addition, the providers get a message saying John Doe is having a severe symptom, and that gives them a mechanism to call them. “The primary aims are to reduce 30-day readmissions and ER visits,” she said.

 A secondary aim of the research is to think about how PROs can be more widely integrated across the health system, said Hazard-Jenkins. “You could see it used in surgery, for the cardiac population with heart failure, and the COPD population. To reduce hospitalizations, you can catch them much faster when they are struggling rather than when they show up in the ER at 3 in the morning.”