Symptom Tracking in Primary Care: Designing and Testing an EHR-Embedded Safety-Net System

Systematic tracking of worrisome symptoms in primary care is an important but underdeveloped safety-net approach for preventing missed or delayed serious diagnoses. A reliable symptom tracking system monitors symptoms (for example, abdominal pain, weight loss) to ensure that they either resolve or appropriate action is taken. Limited examples of reliable symptom tracking systems exist in primary care. The authors aimed to design and test a novel electronic health record (EHR)-embedded symptom tracking system to improve follow-up on worrisome symptoms in a Boston-based primary care community clinic.

Baseline worrisome symptom follow-up rates were determined using historical chart review, measuring whether symptom follow-up was documented and the time to symptom reassessment. A team of systems engineers and primary care clinicians designed and tested iterative prototypes of a worrisome symptom tracking system, resulting in an EHR-embedded tool where symptom tracking orders could be placed and systematically tracked. Measures of success included improved completion rates and timeliness of symptom follow-up using the system compared to historical follow-up rates.

The symptom tracking system was feasible and effective in improving symptom follow-up rates (84.8% vs. 60.5%, p = 0.004) and mean timeliness (20 vs. 101.6 days, p = 0.002) of symptom follow-up compared to historical data.

A pilot symptom tracking system was feasible, accepted by busy primary care clinicians, and resulted in improved reliability and timeliness of symptom follow-up. Broader implementation and evaluation of EHR-embedded symptom tracking systems will require redesigned clinical workflows to optimize the efficiency and sustainability of such systems as a routine component of primary care.