Electronic Patient Reported Outcomes Increase Pediatric Rheumatology Clinic Operations Efficiency While Increasing Patient and Caregiver Satisfaction

Background/Purpose: Patient reported outcomes (PROs) are powerful tools that facilitate communication between patients and their healthcare team.  In paper format, PROs may be incomplete, misplaced and incorrectly scored.  Electronic version (e-form) of PROs may reduce the occurrence of these issues.  As more healthcare institutions move toward electronic medical systems, it is important to assess its impact on healthcare.  Not only is the system impact important, it is imperative to assess patients’ and caregivers’ perspective on these changes.  The objectives of this study were to a) determine whether the e-form could improve efficiency; b) assess user satisfaction with the e-form; and c) identify additional improvements to the e-form.

Methods: An e-form of the Childhood Health Assessment Questionnaire (CHAQ) and the Quality of My Life (QoML) questionnaire was created in REDCap.  Patients/caregivers attending the rheumatology clinic at The Hospital for Sick Children were asked to participate in this quality improvement study by completing both paper and e-form of the PROs (the order of which was determined by a table of random numbers).  They were then asked to complete a satisfaction survey which asked them about their experience and for suggestions on how to improve the e-form.  Changes in efficiency were compared by noting the time differences between both forms as well as calculating the annual differences in cost.  Prior to comparing the times, 2.5 minutes were added to the paper form times to account for scoring and data entry times.  Survey results were analysed using descriptive statistics and thematic identification.

Results: 197/209 participants completed both forms.  The median times to complete the paper forms were longer than completing the e-forms (Table 1).  This was more significant when paper forms were completed prior to e-forms. 

The Division’s costs for photocopying paper forms amounts to ~ $1000/year, whereas the REDCap database cost ~$300 to build and does not require any additional maintenance funding.  Therefore, an e-form results in significant cost savings.

191/209 participants completed the satisfaction survey.  64% (122/191) respondents indicated that they preferred the e-form over the paper form. 

Suggestions for improvements included improving the sliding scale mechanism and increasing the text size.

Conclusion:  Implementation of an e-form resulted in greater efficiency—it was faster and saved money.  Patients also liked it better.  The e-form should be modified to reflect participants’ suggestions and these modifications should be subsequently assessed.

Table 1. Time to complete paper vs. electronic form