A Note From CODE: We are thrilled to welcome Joe Greene, Founder and CEO of OrthoVise, to the blog. Joe is a thought leader on the topic of patient-reported outcomes, and the subject matter expert when it comes to integrating a PRO program with Epic or another EHR based solution.
Catch more of Joe on the OrthoVise blog.
As an organization that collects, stores and reports PRO data for hospitals and medical practices, perhaps the most frequently asked question we get is, “Are you able to integrate with my EHR?” We answer, “YES, of course!” because we do. However, we always follow up our answer with the question, “Do you know what you want to integrate and what does that mean to you?”
One person who is a subject matter expert when it comes to integrating a PRO program with Epic is Joe Greene. Joe has personal experience overseeing PRO integration within a health system from a project management standpoint. He has also advised numerous health systems and practices regarding what they should consider before deciding whether to use an Epic or EHR based solution, or consider outside companies that can deliver this solution for you.
With over three years of experience specific to learning about PRO data collection first hand, and understanding the successes, and challenges, Joe can speak from experience about what to expect when building the solution within your EHR. Our CEO, Breanna Cunningham asked him to give it to us straight, what it’s like collecting and using patient-reported outcome data with Epic.
Q. When it comes to collecting PRO data live within EPIC, and then building out the reporting dashboards, what has been the biggest challenge?
Joe: I wish I could say that there was just one. Clinicians and administration want to collect this data because they realize the increasing importance, but they really are not sure exactly what they want to see in terms of reports. While there are many ways you can integrate with the EHR, I’ll focus on two: putting data back into the EHR and layering PROs with other data.
The first type of consideration is deciding what PRO data you want to collect and display in your EMR.
Unless the organization has been collecting patient-reported outcomes for a while, they are probably not sure what kind of data they want to collect, and then subsequently store discretely and display see in their EHR. This is OK at the beginning, and I recommend waiting until the data starts to come in to figure this out. There is a big resource commitment (time and money) to build custom in Epic, so spending the time to really understand what you want to see in the EHR will save a lot of time, money, and resources.
The second challenge is deciding what other data would be valuable to connect with the PRO data.
This gets more deeply into the integration dialogue and can be a lengthy and complex set of discussions. What’s important to understand is that all this other data can be pulled in retrospectively at any time if you want to perform quality and outcome assessments. You don’t need to prioritize integrating this data right away with other quality measures, but you should be thinking about it.
In both integration cases, a substantial challenge is owned by our providers to really think about what they want to see, and try to standardize data to be reported across a given sub-specialty. I think this is the hardest part of implementing PRO’s in a useful and meaningful way, and it needs dedicated project management support on the IT and Orthopedics side regardless of the PRO collection solution chosen.
To reiterate, once you know what patient populations you want to enroll, and what measures you want to use, the main focus should be on starting to enroll patients, so you can start collecting PRO data as quickly as possible in order to meet regulatory or other requirements. In my experience, building and deploying an Epic solution will not be as efficient as using other external solutions like CODE, and your time to go-live will be extended. There are other benefits to choosing an Epic solution, but it does take a relatively high degree of custom IT workflow build and involve your staff to implement and manage effectively.
Q. Describe what you feel is the necessary workflow you need to create in order to effectively collect PRO Data in Epic?
Joe: I think you need to develop an integrated solution that allows you to collect PRO Data via both the MyChart and Welcome modules. This data can then be made available to the provider and staff to share at the patient care level. If an assigned PRO questionnaire is not completed in MyChart, a Best Practice Alert (BPA) is fired to our MA/Nursing staff in our clinic that indicates a questionnaire needs to be completed. When this happens, a distinct code is delivered which is entered by the staff into a tablet. The tablet is then provided to the patient for them to complete prior to them seeing our provider. Our EPIC build is custom and we display the data in Synopsis. Synopsis is a module of EPIC that allows providers to organize many data points and results in one location. Ideally, the PRO Questionnaire is completed outside of the clinic, instead of in-clinic on a tablet. This obviously eases workflows, but we have experienced that only about 30% of assigned questionnaires are completed via MyChart outside of the clinic. Therefore, we needed a tablet-based Welcome Module solution to complement the MyChart solution. Some of our providers are exceptionally good at showing individual patient care data to patients when they arrive in clinic, but they are in the minority. These physicians also use the data to make individual patient care decisions.
In addition to a great deal of IT hours that need to be dedicated to building a solution like this, there is a substantial investment in hardware, and hardware maintenance and storage, that needs to be considered.
Q. Are you able to benchmark patient and provider outcomes in the EPIC-generated reports?
Joe: In my personal experience, this is an area of great challenge that we still do not have a good solution for. I have heard this from many others as well. EPIC generated reports are not ideal for this and require a high degree of time, effort, and customization. There are not good EPIC generated reports for this purpose that can benchmark internally, and certainly not against other external entities at this time. I think there is a lot of opportunity here to build and incorporate PRO data into overall orthopedics quality dashboards.
Q. About how much time and effort do you think it would take to build out the dashboard capabilities that CODE provides into an EPIC platform?
Joe: That is a great question. I anticipate health systems and practices are underestimating the hours that are involved in building and maintaining their reporting solutions. It is substantial and well into the hundreds of hours.
I am a huge fan of EPIC as an EHR, but specific solutions like PRO collection and reporting are relatively new and immature at this point compared to companies that focus on developing this specific solution. Institutions need to weigh this carefully against the cost of external solutions, as there is a substantial investment of IT resources that you will need to make in order to develop and validate an EHR-based system of PRO data collection. Your staff and providers are also impacted in a large way with an Epic solution as they are responsible for ordering PRO questionnaires accurately, delivering tablets, making changes, etc. This is an often unrecognized impact that needs to be considered.