System-wide integration of patient reported outcome measure collection through an electronic medical record system: A state-wide retrospective study

Abigail R Mokanyk; Christopher L Taylor; Rafael De la Garza Ramos; Swetha Tadepalli; Samantha A Girasulo; Maria C S Rossi; Brooke A O'Donnell; Joel A Bauman; Rajat Sekhar; Khalid M Abbed; Nabil Matmati; Vijay Yanamadala

doi:10.1016/j.jocn.2023.06.009

System-wide integration of patient reported outcome measure collection through an electronic medical record system: A state-wide retrospective study

J Clin Neurosci. 2023 Aug:114:137-143. doi: 10.1016/j.jocn.2023.06.009. Epub 2023 Jun 29.

Affiliations

¹ Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA.
² Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA.
³ Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine in New York City, USA.
⁴ University of Connecticut, College of Liberal Art and Sciences, Storrs, CT 06269, USA.
⁵ Department of Neurosurgery, Hartford HealthCare Medical Group, Hartford, CT 06106, USA.
⁶ Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA.
⁷ Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA. Electronic address: nabil.matmati@hhchealth.org.

PMID: 37392561
DOI: 10.1016/j.jocn.2023.06.009

Abstract

Background and purpose: In spine neurosurgery practice, patient-reported outcome measures (PROMs) are tools used to convey information about a patient's health experience and are an integral component of a clinician's decision-making process as they help guide treatment strategies to improve outcomes and minimize pain. Currently, there is limited research showing effective integration strategies of PROMs into electronic medical records. This study aims to provide a framework for other healthcare systems by outlining the process from start to finish in seven Hartford Healthcare Neurosurgery outpatient spine clinics throughout the state of Connecticut.

Methods: On March 1, 2021, a pilot implementation program began in one clinic and on July 1, 2021, all outpatient clinics were implementing the revised clinical workflow that included the electronic collection of PROMs within the electronic health record (EHR). A retrospective chart analysis studied all adult (18+) new patient visits in seven outpatient clinics by comparing the rates of PROMs collection in Half 1 (March 1, 2021-August 31, 2022) and in Half 2 (September 1, 2022-February 28, 2022) across all sites. Additionally, patient characteristics were studied to identify any variables that may lead to higher rates of collection.

Results: During the study period, 3528 new patient visits were analyzed. There was a significant change in rates of PROMs collection across all departments between H1 and H2 (p < 0.05). Additional significant predictors for PROMs collection were the sex and ethnicity of the patient as well as the provider type for the visit (p < 0.05).

Conclusions: This study proved that implementing the electronic collection of PROMs into an already existing clinical workflow reduces previously identified collection barriers and enables PROMs collection rates that meet or exceed current benchmarks. Our results provide a successful step-by-step framework for other spine neurosurgery clinics to implement a similar approach.

Keywords: EHR (Electronic Health Record); EMR (Electronic Medical Record); NDI (Neck Disability Index); ODI (Oswestry Disability Index); PROMs (Patient-Reported Outcome Measures); Spine clinic.

MeSH terms

Adult
Electronic Health Records*
Humans
Pain*
Patient Reported Outcome Measures
Retrospective Studies
Spine