Background/Purpose: Increasing emphasis has been placed on the use of patient reported outcomes (PROs) in both research and clinical practice. Capturing this data in clinical practice, however, is often challenging for providers and clinical staff: paper forms are easily lost and verbal questions may be rushed or skipped in busy clinics. Many electronic medical record systems (EMRs) have developed patient portal systems with the capacity to electronically administer questionnaires. This study aims to evaluate the use of a patient portal system for collecting PROs in a pediatric rheumatology clinic.

Methods: Response rates to patient reported outcome questionnaires were compared one month pre- and four months post- implementation of an electronic data capture system. Pre-implementation, verbal responses were manually entered into the chart by the physician. Post-implementation, data were captured electronically through our medical record patient portal. Questionnaires were completed on clinic computers or tablets in the waiting or exam room. Questions examined current physical symptoms, performed psychiatric screening, reported both patient pain and fatigue on 0-10 ordinal scales, and allowed entry of any concerns. English and Spanish versions were available. Patients and clinical staff were surveyed about their experiences.

Results:

There were 106 and 307 questionnaires completed pre- and post-implementation, respectively. Post-implementation, the majority of patients/parent-proxies entered their own data. Patient-portal activation increased from 53% to 88% (p<0.01). Higher response rates were seen in psychiatric symptoms after electronic questionnaire implementation. Identification of positive responses pre- and post- electronic questionnaire implementation respectively, are reported: depression increased from 3 to 14% (p<0.01), anxiety increased from 2 to 27% (p<0.01), and difficulty sleeping increased from 16 to 30% (p<0.01). Questionnaires also revealed themes in parental concerns, including “When can we reduce medication?” and “What can we do about her pain?” Physician satisfaction surveys estimated a time savings of 2-5 minutes per visit. Patients reported positive feedback to having portal access and state it allows more time to think about the questions. Furthermore, it introduces patients and their families to other functions within the portal, such as viewing labs and communicating with providers. There were 29 patient-portal correspondence messages prior to implementation and mean of 22 messages/month thereafter. Staff reported there was difficulty with activation of proxy accounts and password recovery workflow.

Conclusion: Integration of novel patient electronic data capture systems within pediatric clinics improve recognition and identification of psychiatric symptoms. It can also save valuable physician time. Improved discrete data capture is necessary to further improve clinical systems and patient care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/integration-of-electronically-captured-patient-reported-outcomes-in-a-pediatric-rheumatology-clinic-visit/