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Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record

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Abstract

The objective of this research was to assess the implementation of collecting patient-reported outcomes data in the outpatient clinics of a large academic hospital and identify potential barriers and solutions to such an implementation. Three PROMIS computer adaptive test instruments, (1) physical function, (2) pain interference, and (3) depression, were administered at 23,813 patient encounters using a novel software platform on tablet computers. The average time to complete was 3.50 ± 3.12 min, with a median time of 2.60 min. Registration times for new patients did not change significantly, 6.87 ± 3.34 to 7.19 ± 2.69 min. Registration times increased for follow-up (p = .007) from 2.94 ± 1.57 (p < .01) min to 3.32 ± 1.78 min. This is an effective implementation strategy to collect patient-reported outcomes and directly import the results into the electronic medical record in real time for use during the clinical visit.

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Correspondence to J. F. Baumhauer.

Appendix 1: Patient-reported outcomes measurement information system

Appendix 1: Patient-reported outcomes measurement information system

Frequently asked questions

PROMIS

Q. What is the purpose of the PROMIS health assessment?

A. The health assessment gives your provider a clear understanding/snapshot of how you are feeling today and helps them work with you in developing a treatment plan.

Q. Who is requesting this information and why?

A. Your physician is requesting this information and it is Standard of Care (like taking blood pressure).

Q. Where do my answers go?

A. Your answers are electronically uploaded into your medical record and are ready for today’s visit.

Q. Can I see my answers in “My Chart”?

A. No, it is not linked to My Chart; however, your provider can show you YOUR information. Only your provider and other medical professionals with access to your medical record can view your answers.

Q. Am I answering this about my injury/surgery or my health in general?

A. Your general health, which includes what brought you here today. Your answers should be related to how you feel today, a “snapshot” in time.

Q. Do I have to do this every time I come? Why?

Yes. The Health Assessment is Standard of Care and updates your provider on how you are doing today.

Q. Are the questions the same every time?

A. The questions are generated based on the answers that you give. If your prior answer is the same, the next question will be the same. If you answer differently, it triggers a new question.

Q. How long does the assessment take?

A. It only takes a few minutes to complete the assessment.

Q. Why do I have to answer questions that don’t seem to apply to me?

A. It is important for your provider to know if you are able to do the daily activities you normally do or enjoy doing.

Q. Can I decline?

A. Yes, you can opt-out if you wish; however, this is your opportunity to update your provider on how you are feeling today. This information can be used as part of your discussions with your doctor to develop your treatment plan and to monitor your progress.

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Papuga, M.O., Dasilva, C., McIntyre, A. et al. Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record. Health Syst (2017). https://doi.org/10.1057/s41306-016-0016-1

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  • DOI: https://doi.org/10.1057/s41306-016-0016-1

Keywords

  • orthopaedic outcomes
  • patient-reported outcomes
  • PROMIS
  • physical function
  • pain
  • depression