Implementing Electronic Symptom Screening for Telehealth Visits (2020-2021)

Background Cancer survivors, and those living with the disease, experience a cadre of issues and symptoms that often go unrecognized or are inadequately addressed. Research shows that the collection and monitoring of patients' symptoms using electronic Patient Reported Outcomes (ePROs) assessments can enhance care and lead to improved quality of life, prolonged survival and reduced resource utilization. The Duke Cancer Institute has successfully implemented ePRO assessments into routine in-person cancer care visits. The coronavirus pandemic has led to a rapid increase in telehealth visits, including for routine cancer care. At the same time, the pandemic has resulted in new unmet patient needs. There is currently no method for collecting and utilizing ePRO symptom screening data in the context of telehealth visit workflows to proactively identify and mitigate patients' unmet symptoms and needs. Improved screening using ePRO tools is now more crucial than ever as clinicians aim to reduce unscheduled physician appointments, emergency department visits and hospitalizations - all of which are high-risk visits for cancer patients during the pandemic. Project Description Drawing on the prior process used by the Duke Cancer Institute when implementing the ePRO for in-person visits, this project team will develop a new workflow to integrate and assess the ePRO tool into telehealth visits at the Duke Cancer Institute. By integrating the ePRO assessment into telehealth visits, the team will have the opportunity to improve care for cancer patients and reduce riskier health visits. If proven successful, this model has the potential to scale to other parts of the health system. Specifically, this team will: Develop a new workflow to integrate ePRO into telehealth visits: Team members will develop nursing and clinician workflows pertaining to the collection, review and triage of ePRO information for telehealth cancer care visits. They will then test and implement a process for contacting patients who report bothersome symptoms (those at the moderate or severe level) to improve care between scheduled appointments Implement the new workflow and monitor for necessary process improvements: The team will partner with Duke Cancer Institute clinics to implement this novel telehealth ePRO approach as well as identify and implement needed process improvements. Assess use and effectiveness of the ePRO implementation: Team members will use data analytics to assess clinician utilization of ePROs prior to telehealth visits; interview staff and clinicians to assess their experiences with the eRPO implementation; and interview patients to collect feedback on their satisfaction and use of the ePRO as part of their telehealth visit. Anticipated Outputs Implementation of ePRO data collection as part of telehealth visit workflows; improved symptom assessment in patients with cancer; collection of rich patient experience data for more targeted treatment; enhanced quality of care; reduced downstream healthcare utilization; qualitative insights regarding participants' experiences using ePROs as part of telehealth visits; research posters and manuscripts