INTEGRATING THE PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM (PROMIS) SYMPTOM ASSESSMENT INTO ROUTINE CANCER CARE

Purpose:    To implement the administration and meaningful use of efficient NIH Patient Reported Outcomes Measurement Information System (PROMIS) assessments of pain interference, fatigue, physical function, depression and anxiety into oncology clinical care, in an electronic health record (EHR) environment.

Methods:    Outpatients receiving oncology care in a gynecologic oncology clinic that utilizes a patient communication portal account (Epic “MyChart”) receive an e-mail message 72 hours prior to their scheduled physician visit, with instructions to complete an online assessment. The MyChart message contains a web-link that connects patients seamlessly to Assessment Center,^TMa web-based platform that administers PROMIS computer adaptive tests (CATs). Assessment included 5 PROMIS CATs (pain interference, fatigue, physical function, depression and anxiety) plus questions to assess social work needs and risk factors for poor nutritional status. Participants who do not complete the assessment at home are provided with an iPad to complete the assessment in-clinic. Scores from completed assessments are automatically populated in the patient’s EHR and may be viewed by clinical care providers. Symptom scores in the severe range (T-score > 70) trigger a message notification to the patient’s treating oncologist and nursing message pool in the EHR. Patients reporting distress, social work needs or nutrition concerns are automatically triaged through the EHR. Psychosocial distress and social work needs trigger a message notification to the social work pool in the EHR. Nutritional concerns trigger message notifications to the dietitian EHR pool. Information requests trigger message notifications to the health learning center EHR pool.

Results:    A total of 311 women have completed the assessment; 258 (83%) at home and 53 (17%) in-clinic. PROMIS CAT T-score descriptive statistics are presented in the table below, including the number of scores in the severe range prompting clinician message notification.

	Fatigue	Pain	Physical function	Anxiety	Depression
Mean	50.7	49.5	45.8	53.3	49.5
Range	24.3 - 84.7	38.6 - 83.8	15.4 - 73.3	32.9 - 84.9	34.2 - 84.4
Standard deviation	10.1	10.3	9.4	9.1	8.6
Triggers	10	9	14	1	1

Conclusion:    We have demonstrated a model for the integration of PROMIS CATs in an EHR system, resulting in automated population of results in the EHR, notification of clinicians when severe symptoms are reported, and automated triage for supportive oncology care.