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Electronic Medical Records (EMRs) primarily center around electronically documenting patients' health information within a single healthcare organization or practice. They contain essential clinical data related to a patient's medical history, diagnoses, medications, treatment plans, lab results, and other pertinent information relevant to the specific encounter or episode of care. EMRs are designed to streamline documentation and workflow processes within individual healthcare...
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Seamless Integration of Computer-Adaptive Patient Reported Outcomes into an Electronic Health Record.

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Integrating Patient-Reported Outcomes Measurement Information System (PROMIS) computer-adaptive tests (CATs) into the electronic health record (EHR) enhances patient care. This seamless integration improves data collection and clinical decision-making for better health outcomes.

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Area of Science:

  • Health Informatics
  • Clinical Quality Measurement
  • Patient-Centered Care

Background:

  • Patient-reported outcome (PRO) measures are crucial for quality assessment and patient engagement in healthcare.
  • The National Institutes of Health established the Patient-Reported Outcomes Measurement Information System (PROMIS) in 2004, utilizing computer-adaptive tests (CATs) for precise measurement with reduced patient burden.
  • Integrating PROs into electronic health records (EHRs) is essential for clinical use, necessitating innovative IT solutions.

Purpose of the Study:

  • To describe the integration of PROMIS CATs into the Epic Systems EHR at a major academic medical center.
  • To detail the creation of a secure, automated connection between the PROMIS CATs application programming interface (API) and the Epic EHR.

Main Methods:

  • Developed custom middleware software to ensure seamless integration without compromising data security.
  • Configured middleware to connect the Assessment Center API (for CAT scoring and item selection) with Epic (for item presentation and results).
  • Ensured CATs appeared identical to conventional measures within the EHR, including automatic charting of PROMIS scores.

Main Results:

  • The middleware solution was successfully implemented across 27 clinics within the hospital system.
  • Over 70,000 PROs were collected from patients by 793 providers within the first two years of hospital-wide adoption.

Conclusions:

  • Effective integration of clinical software requires robust interdisciplinary team communication during design and development.
  • Successful implementation hinges on securing buy-in from clinical stakeholders to integrate new tools into established workflows.