eSyM: An Electronic Health Record-Integrated Patient-Reported Outcomes-Based Cancer Symptom Management Program Used by Six Diverse Health Systems

Michael J. Hassett, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
Christine Cronin, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
Terrence C. Tsou, Johns Hopkins University School of Medicine, Baltimore, MD.
Jason Wedge, Epic, Verona, WI.
Jessica Bian, Maine Medical Center, Portland, ME.
Don S. Dizon, Lifespan Cancer Institute and Brown University, Providence, RI.
Hannah Hazard-Jenkins, West Virginia University Cancer Center, Morgantown, WV.
Raymond U. Osarogiagbon, Baptist Medical Center, Memphis, TN.
Sandra Wong, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Ethan Basch, Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC.
Toby Austin, Epic, Verona, WI.
Nadine McCleary, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
Deborah Schrag, Memorial Sloan Kettering Cancer Center, New York, NY.


PURPOSE: Collecting patient-reported outcomes (PROs) can improve symptom control and quality of life, enhance doctor-patient communication, and reduce acute care needs for patients with cancer. Digital solutions facilitate PRO collection, but without robust electronic health record (EHR) integration, effective deployment can be hampered by low patient and clinician engagement and high development and deployment costs. The important components of digital PRO platforms have been defined, but procedures for implementing integrated solutions are not readily available. METHODS: As part of the NCI's IMPACT consortium, six health care systems partnered with Epic to develop an EHR-integrated, PRO-based electronic symptom management program (eSyM) to optimize postoperative recovery and well-being during chemotherapy. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Whenever possible, the system used validated content from the public domain and took advantage of existing EHR capabilities to automate processes. RESULTS: eSyM includes symptom surveys on the basis of the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) plus two global wellness questions; reminders and symptom self-management tip sheets for patients; alerts and symptom reports for clinicians; and population management dashboards. EHR dependencies include a secure Health Insurance Portability and Accountability Act-compliant patient portal; diagnosis, procedure and chemotherapy treatment plan data; registries that identify and track target populations; and the ability to create reminders, alerts, reports, dashboards, and charting shortcuts. CONCLUSION: eSyM incorporates validated content and leverages existing EHR capabilities. Build challenges include the innate technical limitations of the EHR, the constrained availability of site technical resources, and sites' heterogenous EHR configurations and policies. Integration of PRO-based symptom management programs into the EHR could help overcome adoption barriers, consolidate clinical workflows, and foster scalability and sustainability. We intend to make eSyM available to all Epic users.