Developing Design Principles to Integrate PROs into clinical practice through HIT: Data, user experience, and workflow requirements for PRO Dashboards

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 DESCRIPTION (provided by applicant): Incorporating Patient-Reported Outcomes (PROs) into clinical assessments and decision making improves patient-provider communication, patient satisfaction, and treatment monitoring. Although PRO data is starting to be included in health information technology (HIT) platforms, most healthcare providers have little experience using PRO displays or incorporating PRO data into health care activities. As part of the Agency for Healthcare Research and Quality-sponsored Washington State Comparative Effectiveness Research Translation Network (CERTAIN), we began a process of sharing PRO data with healthcare providers in clinics across Washington State in 2012. We developed a prototype web-based PRO platform (PROs in Practice) for collecting and presenting PROs to healthcare teams. Focusing on the presentation of PROs through a dashboard, we recruited physicians, nurses, and other members of healthcare teams to provide feedback about the platform's form and function. This pilot work uncovered large gaps in evidence about the needs of those users for integrating PROs into their practice. We found that simply adding PRO metrics to structured medical records led to unintended consequences. Healthcare practitioners and staff raised concerns about the negative impact of using PRO dashboards on clinic workflow, the need to tailor visual displays to the needs of different types of healthcare team members, and uncertainties related to missing data and validity. To more effectively integrate PROs into clinical care, a set of evidence-based design principles related to workflow, user-experience, and validity/interpretability specific to PROs needs to be developed. To address this gap we plan to work across CERTAIN's clinical sites and employ systems engineering methods, human-centered design, and mixed-research methods to develop design principles that will ultimately enable more effective integration of PRO data into patient care activities through HIT. We propose three aims: (1) Evaluate the information needs and healthcare decision making processes regarding the integration and interpretability of PRO data; (2) Specify healthcare practitioner user requirements for interactive PRO visualizations through human-centered methods; and (3) Characterize clinical workflow needs and impact associated with integration of PROs into clinical care activities through HIT platforms. There is broad interest in incorporating PRO data into clinical care, but important questions remain about how these data can be most effectively used without a negative impact. The proposed studies address fundamental issues for HIT related to PROs and will inform design principles related to workflow, optimal user experience, and data comprehension and interpretation. Since they are being developed in a diverse statewide network, these design principles are likely to be relevant to others across the nation who are, or will soon be, working on effective integration of PROs into clinical care.