Patient Reported Outcomes
Areas of Focus:
Design, Development

Improving Patient-Reported Outcomes for Remote Patient Monitoring

Much of our modern healthcare system revolves around isolated patient visits, giving clinicians a limited view of patient health in their daily lives. As more health conditions become chronic rather than acute, the isolated snapshots doctors get during office visits are proving to be inadequate. Remote monitoring of Patient-Reported Outcome Measures (known as PROMs or PROs) can give clinicians a helpful window into a patient’s ongoing condition and recovery but adoption has been hindered by interoperability issues.

Collecting PRO data through remote patient monitoring gives clinicians significantly better data but adds new layers of complication. Integrating PRO data into clinicians’ electronic medical records (EMRs) is one of the main barriers to adoption. The Agency for Healthcare Research and Quality (AHRQ) created the Step Up Challenge with the hope of creating an innovative user-friendly app capable of collecting standardized PRO data in a variety of ambulatory settings that can then be integrated with EMR systems using Fast Healthcare Interoperability Resources (FHIR) data standards.

EHR Integrated via FHIR API


We collaborated with academic and clinical researchers at the University of Minnesota’s Carlson School of Management and the Institute for Health Informatics, and Fairview Health System/HealthEast Kidney Stone Institute, to conceive of better ways to collect PROs for remote patient monitoring. Together, we formulated a strategy to increase the adoption of PROs through an easy-to-use web and mobile application called PRISM (Patient Reporting and Insight System from Minnesota).

PRISM relies on a computer-adaptive assessment system to administer an evidence-based set of questions — which change based on the user’s answers — derived from the Patient-Reported Outcomes Measurement Information System (PROMIS). The researchers at Northwestern University behind PROMIS have developed “a rigorously tested patient reported outcome (PRO) measurement tool that uses recent advances in information technology, psychometrics, and qualitative, cognitive, and health survey research to measure PROs such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality-of-life across a variety of chronic diseases.”  

While PROMIS has been used successfully in-clinic, there was no interface or infrastructure to collect initial and follow up patient responses digitally. PRISM brings the data-driven PROMIS measures to an easy-to-use patient-facing app that encourages users to check in weekly and respond to a computer-adaptive set of questions to deliver more accurate PROs. We achieved this by implementing a four-step human-centered design approach:

  • Step 1) We conducted interviews with clinicians and other stakeholders to understand their needs
  • Step 2) We interviewed patients to understand their preferences
  • Step 3) Our team created an interactive prototype and conducted user testing with real patients in-clinic
  • Step 4) We iterated on the prototype for a total of four rounds of testing until quantitative and qualitative feedback told us that the product was highly usable and met the goals of the users
“This app is an innovative tool that will advance value- and person-centered care by ensuring that information generated by patients is a major driver in their care. PRISM will help overcome challenges in collecting and integrating standardized PRO data into health information technology systems.”
Gopal Khanna
AHRQ Director

The Winning App

The PRISM app achieved usability scores 40% higher than popular consumer applications — even when testing with patients who have a low technology literacy — to win AHRQ’s Step Up App Challenge. Adoption of this app gave patients a stronger voice in their care and clinicians better clinical decision support.

We successfully completed a pilot study with patients at MedStar Health, and shared helpful lessons with the research community about creating a PRO solution that provided more value to patients, had higher data capture rates, and seamlessly integrated with clinical workflow. For example, half of the users found population comparisons to be very helpful — while others told us it was important to make those statistics more patient-friendly.

Importantly, PRISM also successfully demonstrated the use of FHIR and SMART on FHIR specifications in a serverless architecture — allowing the data to be integrated into EMRs to allow easy access to providers without the need to sign into another system. The ability to integrate with EMRs is integral to turning the PROs into data clinicians can actually use to improve care — and the use of SMART on FHIR specifications effectively future-proofs PRISM and makes it accessible to a wide swath of clinics with relatively few tweaks.  

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