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Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience

Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans... PURPOSEThere are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom presence and severity. Integrating PRO tools in EHRs can alert providers to address symptoms, which is an essential component of comprehensive oncology care.METHODSWe modified a PRO used to measure cancer and end-of-life symptoms, the Edmonton Symptom Assessment System to create the Veteran Symptom Assessment System (VSAS). VSAS was implemented as an integrated PRO as part of the Veterans Administration EHR system and was used at hematology-oncology clinics in Veteran Administration (VA) medical centers in the Southeast.RESULTSFrom 2013 to 2014, VSAS was introduced, underwent usability testing and modifications, and was finally implemented in the EHR. Between 2015 and 2019, VSAS was administered 43,883 times in 9,058 patients. Eighty-nine percent of Veterans were male, 11% were female, 52% identified as non-Hispanic White, and 43% identified as African American. Fatigue, shortness of breath with exertion, and pain were most frequently reported initially (68%, 48%, and 45%, respectively) and were most frequently rated as severe (27%, 16%, and 17%, respectively). In patients diagnosed with stage IV cancer, higher symptom burden was significantly associated with shorter overall survival. The majority of Veterans with longitudinal measurements experienced improvement in symptoms, most frequently in severe symptoms.CONCLUSIONTo our knowledge, this is the first large-scale implementation of a PRO system, integrated in the VA EHR, in ambulatory patients with cancer and blood disorders. The integration of VSAS within the VA EHR is a significant demonstration and a necessary requirement for current and future systemic initiatives in cancer symptom management. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JCO: Clinical Cancer Informatics Wolters Kluwer Health

Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience

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Publisher
Wolters Kluwer Health
Copyright
 Published by American Society of Clinical Oncology
eISSN
2473-4276
DOI
10.1200/cci.21.00086
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Abstract

PURPOSEThere are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom presence and severity. Integrating PRO tools in EHRs can alert providers to address symptoms, which is an essential component of comprehensive oncology care.METHODSWe modified a PRO used to measure cancer and end-of-life symptoms, the Edmonton Symptom Assessment System to create the Veteran Symptom Assessment System (VSAS). VSAS was implemented as an integrated PRO as part of the Veterans Administration EHR system and was used at hematology-oncology clinics in Veteran Administration (VA) medical centers in the Southeast.RESULTSFrom 2013 to 2014, VSAS was introduced, underwent usability testing and modifications, and was finally implemented in the EHR. Between 2015 and 2019, VSAS was administered 43,883 times in 9,058 patients. Eighty-nine percent of Veterans were male, 11% were female, 52% identified as non-Hispanic White, and 43% identified as African American. Fatigue, shortness of breath with exertion, and pain were most frequently reported initially (68%, 48%, and 45%, respectively) and were most frequently rated as severe (27%, 16%, and 17%, respectively). In patients diagnosed with stage IV cancer, higher symptom burden was significantly associated with shorter overall survival. The majority of Veterans with longitudinal measurements experienced improvement in symptoms, most frequently in severe symptoms.CONCLUSIONTo our knowledge, this is the first large-scale implementation of a PRO system, integrated in the VA EHR, in ambulatory patients with cancer and blood disorders. The integration of VSAS within the VA EHR is a significant demonstration and a necessary requirement for current and future systemic initiatives in cancer symptom management.

Journal

JCO: Clinical Cancer Informatics – Wolters Kluwer Health

Published: Mar 15, 2022

References

  • Oh, the places we'll go: Patient-reported outcomes and electronic health records
    Gensheimer, SG; Wu, AW; Snyder, CF
  • Innovations in research and clinical care using patient-generated health data
    Jim, HSL; Hoogland, AI; Brownstein, NC
  • Patient-reported outcomes (PROs): Putting the patient perspective in patient-centered outcomes research
    Snyder, CF; Jensen, RE; Segal, JB
  • Patient-generated health data and electronic health record integration: A scoping review
    Tiase, VL; Hull, W; McFarland, MM
  • The symptom burden of cancer: Evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study
    Cleeland, CS; Zhao, F; Chang, VT
  • A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment
    Reilly, CM; Bruner, DW; Mitchell, SA
  • Quality of life (QOL) and symptom burden (SB) in patients with breast cancer
    Hamer, J; McDonald, R; Zhang, L
  • Relationship among symptom clusters, quality of life, and treatment-specific optimism in patients with cancer
    Matzka, M; Kock-Hodi, S; Jahn, P
  • Patient self-reports of symptoms and clinician ratings as predictors of overall cancer survival
    Quinten, C; Maringwa, J; Gotay, CC
  • Prognostic value of patient-reported outcomes from international randomised clinical trials on cancer: A systematic review
    Mierzynska, J; Piccinin, C; Pe, M
  • National Institutes of Health State-of-the-Science Conference Statement: Symptom management in cancer: Pain, depression, and fatigue, July 15-17, 2002
    Patrick, DL; Ferketich, SL; Frame, PS
  • Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial
    Basch, E; Deal, AM; Kris, MG
  • Cancer incidence among patients of the U.S. Veterans Affairs Health Care System: 2010 update
    Zullig, LL; Sims, KJ; McNeil, R
  • The Edmonton Symptom Assessment System 25 years later: Past, present, and future developments
    Hui, D; Bruera, E
  • The Edmonton Symptom Assessment System: A 15-year retrospective review of validation studies (1991-2006)
    Nekolaichuk, C; Watanabe, S; Beaumont, C
  • Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
    Quan, H; Sundararajan, V; Halfon, P
  • Current concepts in validity and reliability for psychometric instruments: Theory and application
    Cook, DA; Beckman, TJ
  • Making sense of Cronbach's alpha
    Tavakol, M; Dennick, R
  • Symptom clusters in patients with advanced cancers
    Cheung, WY; Le, LW; Zimmermann, C
  • Symptom burden and performance status in a population-based cohort of ambulatory cancer patients
    Barbera, L; Seow, H; Howell, D
  • Changes in symptom intensity among cancer patients receiving outpatient palliative care
    Kang, JH; Kwon, JH; Hui, D
  • Prevalence, comorbidity, and prognosis of mental health among US Veterans
    Trivedi, RB; Post, EP; Sun, H
  • Symptoms tell it all: A systematic review of the value of symptom assessment to predict survival in advanced cancer patients
    Trajkovic-Vidakovic, M; de Graeff, A; Voest, EE
  • Minimal clinically important differences in the Edmonton symptom assessment scale in cancer patients: A prospective, multicenter study
    Hui, D; Shamieh, O; Paiva, CE
  • Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use
    Agha, Z; Lofgren, RP; VanRuiswyk, JV
  • Demographic, military, and health characteristics of VA health care users and nonusers who served in or during Operation Enduring Freedom or Operation Iraqi Freedom, 2009-2011
    Dursa, EK; Barth, SK; Bossarte, RM
  • Racial differences in pain during 1 year among women with metastatic breast cancer: A hazards analysis of interval-censored data
    Castel, LD; Saville, BR; Depuy, V
  • Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer?
    Martinez, KA; Snyder, CF; Malin, JL
  • Severe pain in Veterans: The effect of age and sex, and comparisons with the general population
    Nahin, RL
  • Racial disparities in traumatic stress in prostate cancer patients: Secondary analysis of a national URCC CCOP study of 317 men
    Purnell, JQ; Palesh, OG; Heckler, CE
  • Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer
    Yee, MK; Sereika, SM; Bender, CM