Electronic eRAPID3 (Routine Assessment of Patient Index Data): opportunities and complexities

RAPID3 (routine assessment of patient index data) is an index found within a multi-dimensional health assessment questionnaire (MDHAQ) for routine clinical care, composed only of 3 self-report scores for physical function, pain, and patient global estimate, each scored 0-10, for a total of 0-30. RAPID3 is correlated significantly with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index), and distinguishes active from control treatments as efficiently as these indices in clinical trials involving adalimumab, abatacept, certolizumab, infliximab, and rituximab. Many versions of an electronic RAPID3 (eRAPID3) have been developed, which are incompatible with one another, as seen for electronic medical records (EMR). Therefore, opportunities are lost to pool data from many sites for advancement of patient care and outcomes. Interfaces for linkage to EMRs and pooling of data are available as Health Level Seven (HL7) standards, FHIR (Fast Health Interoperability Resources), and innovative open platforms like SMART (Substitutable Medical Apps, Reusable Technology), but many eRAPID3 versions do not have this capacity. RAPID3 scores may be elevated in many patients due to damage or distress, rather than, or in addition to, inflammation, a problem that also affects DAS28, CDAI, and all RA indices which include a patient global estimate, even if they include a formal joint count. A full MDHAQ, of which RAPID3 is a component, provides clues to the presence of damage, and/or distress and adds much further information, with no more work for the health professional and little more time for the patient. A RheuMetric physician checklist of global scores for inflammation, damage, and distress is also useful to recognise damage and/or distress, but not available with most available eRAPID3 versions. Many eRAPID3 versions also are limited by the absence of flowsheets to monitor scores over time, the absence of strategies to convey data to health professionals to improve care, and the absence of advanced features for patients and doctors which are available in some versions of an eRAPID3. It is recommended that eRAPID3 should include a full MDHAQ, RheuMetric checklist, a longitudinal flowsheet of scores, and a defined strategy for management of the data to be available to the physician for improved patient care, to enhance value and quantitative interpretation of RAPID3 scores.