Designing an Electronic Patient-Reported Outcomes Information Infrastructure Supported by the RE-AIM Implementation Framework

Authors

Amy C. Moreno, The University of Texas MD Anderson Cancer CenterFollow
Angela Peek, The University of Texas MD Anderson Cancer CenterFollow
Toshiko S. Stein, The University of Texas MD Anderson Cancer CenterFollow
Kevin R. Shook, The University of Texas MD Anderson Cancer CenterFollow
Sara M. Ali, The University of Texas MD Anderson Cancer CenterFollow
Laia Humbert-Vidan, The University of Texas MD Anderson Cancer CenterFollow
Aileen Chen, The University of Texas MD Anderson Cancer CenterFollow
Miriam Lango, The University of Texas MD Anderson Cancer CenterFollow
Anna Lee, The University of Texas MD Anderson Cancer CenterFollow
Michael Spiotto, The University of Texas MD Anderson Cancer CenterFollow
William H. Morrison, The University of Texas MD Anderson Cancer CenterFollow
Adam S. Garden, The University of Texas MD Anderson Cancer CenterFollow
Jack Phan, The University of Texas MD Anderson Cancer CenterFollow
Steven J. Frank, The University of Texas MD Anderson Cancer CenterFollow
Katherine Hutcheson, The University of Texas MD Anderson Cancer CenterFollow
David I. Rosenthal, The University of Texas MD Anderson Cancer CenterFollow
Clifton D. Fuller, The University of Texas MD Anderson Cancer CenterFollow
G Brandon Gunn, The University of Texas MD Anderson Cancer CenterFollow

Abstract

Objective: Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (reach-effectiveness-adoption-implementation-maintenance) principles.

Materials and Methods: We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were established and used to design patient, provider, and implementing facilitator information tools.

Results: From January 2021 to July 2024, our ePRO program has collected 13,156 patient-submitted ePROs on 3,497 unique HN patients, with a 12-month sustained ePRO compliance rate of 82%. We also propose a dynamic 2-cycle implementation model. This model can be used to continuously (re)define, build, and adapt ePRO information tools for patients, providers, and program facilitators.

Discussion: Our ePRO framework has several benefits, including integrated clinical data for enhanced decision-making, potential scalability, and use of a common EHR system. Formative (ie, mid-phase) evaluations were essential to our program, allowing for timely optimization of ePRO compliance, ePRO usage by clinical staff, and secondary use of high-quality ePRO data.

Conclusion: In this article, we provide a valuable roadmap toward developing a comprehensive, EHR-based ePRO information infrastructure simultaneously optimized for clinical utility, informatics operations, and implementation evaluation founded on RE-AIM principles.

PMCID

PMC11998853

DOI

https://doi.org/10.52519/ACEQI.25.1.2.a6

Grants and Funding

K0 1DE030524/NNIH

P01 CA285249-01A1/NIH

K12 CA088084/NCI NIH

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Recommended Citation

Moreno AC, Peek A, Stein TS, Shook KR, Ali SM, Humbert-Vidan L, Chen A, Lango M, Lee A, Spiotto M, Morrison WH, Garden AS, Phan J, Frank SJ, Hutcheson K, Rosenthal DI, Fuller CD, Gunn GB. Designing an Electronic Patient-Reported Outcomes Information Infrastructure Supported by the RE-AIM Implementation Framework. Advances in Cancer Education and Quality Improvement. 2025; 1(2). doi: https://doi.org/10.52519/ACEQI.25.1.2.a6.