eSyM: An Electronic Health Record-Integrated Patient-Reported Outcomes-Based Cancer Symptom Management Program Used by Six Diverse Health Systems.
eSyM: An Electronic Health Record-Integrated Patient-Reported Outcomes-Based Cancer Symptom Management Program Used by Six Diverse Health Systems.
复制标题
DOI：
10.1200/cci.21.00137
复制
发表时间：
2022-01
影响因子：
4.2
通讯作者：
Schrag, Deborah
中科院分区：
文献类型：
--
作者：
Hassett, Michael J.;Cronin, Christine;Tsou, Terrence C.;Wedge, Jason;Bian, Jessica;Dizon, Don S.;Hazard-Jenkins, Hannah;Osarogiagbon, Raymond U.;Wong, Sandra;Basch, Ethan;Austin, Toby;McCleary, Nadine;Schrag, Deborah
收集患者报告的结果（PRO）可以改善症状控制和生活质量，加强医患沟通，减少癌症患者的急性护理需求。数字解决方案有助于PRO收集，但如果没有强大的电子健康记录（EHR）集成，有效的部署可能会受到患者和临床医生参与度低以及开发和部署成本高的阻碍。数字PRO平台的重要组成部分已经确定，但实施综合解决方案的程序还没有现成的。作为NCI IMPACT联盟的一部分，六个医疗保健系统与Epic合作开发了一个集成EHR的、基于PRO的电子症状管理程序（eSyM），以优化化疗期间的术后恢复和健康。敏捷开发过程纳入了以用户为中心的设计原则，需要患者、临床医生和医疗保健系统的参与。只要有可能，该系统就使用来自公共领域的经过验证的内容，并利用现有的EHR功能来自动化流程。eSyM包括基于PRO不良事件通用术语标准（PRO-CTCAE）的症状调查以及两个全球健康问题;患者提醒和症状自我管理提示表;临床医生的警报和症状报告;和人口管理仪表板。EHR依赖性包括一个安全的符合健康保险可携带性和责任法案的患者门户网站;诊断，程序和化疗治疗计划数据;识别和跟踪目标人群的注册表;以及创建提醒，警报，报告，仪表板和图表快捷方式的能力。eSyM整合了经过验证的内容，并利用了现有的EHR功能。构建挑战包括EHR的固有技术限制、站点技术资源的受限可用性以及站点的异构EHR配置和策略。将基于PRO的症状管理程序集成到EHR中可以帮助克服采用障碍，巩固临床工作流程，并促进可扩展性和可持续性。我们打算向所有Epic用户提供eSyM。
Collecting patient-reported outcomes (PROs) can improve symptom control and quality of life, enhance doctor-patient communication, and reduce acute care needs for patients with cancer. Digital solutions facilitate PRO collection, but without robust electronic health record (EHR) integration, effective deployment can be hampered by low patient and clinician engagement and high development and deployment costs. The important components of digital PRO platforms have been defined, but procedures for implementing integrated solutions are not readily available. As part of the NCI's IMPACT consortium, six health care systems partnered with Epic to develop an EHR-integrated, PRO-based electronic symptom management program (eSyM) to optimize postoperative recovery and well-being during chemotherapy. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Whenever possible, the system used validated content from the public domain and took advantage of existing EHR capabilities to automate processes. eSyM includes symptom surveys on the basis of the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) plus two global wellness questions; reminders and symptom self-management tip sheets for patients; alerts and symptom reports for clinicians; and population management dashboards. EHR dependencies include a secure Health Insurance Portability and Accountability Act-compliant patient portal; diagnosis, procedure and chemotherapy treatment plan data; registries that identify and track target populations; and the ability to create reminders, alerts, reports, dashboards, and charting shortcuts. eSyM incorporates validated content and leverages existing EHR capabilities. Build challenges include the innate technical limitations of the EHR, the constrained availability of site technical resources, and sites' heterogenous EHR configurations and policies. Integration of PRO-based symptom management programs into the EHR could help overcome adoption barriers, consolidate clinical workflows, and foster scalability and sustainability. We intend to make eSyM available to all Epic users.