title: The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings.
abstract: BACKGROUND
  People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits.
  
  
  OBJECTIVE
  This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy.
  
  
  METHODS
  A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage.
  
  
  RESULTS
  Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients.
  
  
  CONCLUSIONS
  Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial.
authors.affiliation: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. csteele@bridgepointhealth.ca.
authors.forename: Carolyn
authors.identifier: http://orcid.org/0000-0002-2146-0001
authors.initials: C
authors.lastname: Steele Gray
authors.forename: Ashlinder
authors.identifier: http://orcid.org/0000-0001-6775-1181
authors.initials: A
authors.lastname: Gill
authors.forename: Anum Irfan
authors.identifier: http://orcid.org/0000-0003-4021-7119
authors.initials: AI
authors.lastname: Khan
authors.forename: Parminder Kaur
authors.identifier: http://orcid.org/0000-0002-8641-0582
authors.initials: PK
authors.lastname: Hans
authors.forename: Kerry
authors.identifier: http://orcid.org/0000-0002-6377-6653
authors.initials: K
authors.lastname: Kuluski
authors.forename: Cheryl
authors.identifier: http://orcid.org/0000-0002-9986-3863
authors.initials: C
authors.lastname: Cott
keywords: eHealth; feasibility; mHealth; multimorbidity; pilot; primary care; usability