title: Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report.
abstract: In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden.
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA charle@phhp.ufl.edu.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Harle
authors.affiliation: Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Alyson
authors.initials: A
authors.lastname: Listhaus
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Constanza M
authors.initials: CM
authors.lastname: Covarrubias
authors.affiliation: Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Siegfried Of
authors.initials: SO
authors.lastname: Schmidt
authors.affiliation: Department of Anesthesiology, Stanford University, Palo Alto, CA, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Mackey
authors.affiliation: Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carek
authors.affiliation: Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hurley
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D057286:Electronic Health Records; D005194:Family Practice; D006801:Humans; D019982:Organizational Case Studies; D063868:Patient Outcome Assessment
keywords: clinical informatics; electronic health record; patient outcome assessment; patient-reported outcomes; primary care; work flow