Barriers Preventing Widespread Adoption of Electronic Patient-Reported Symptoms

Although the electronic reporting of patient symptoms between visits has proven health benefits, cost and technological barriers are preventing the widespread implementation, according to a new study.

In a study published in the New England Journal of Medicine, investigators reiterated the need for electronic symptom reporting and the issues preventing it.

“There’s tremendous value in integrating these patient-reported symptoms and other measures of how patients are feeling into clinical practice,” said investigator Ethan Basch, MD. “We’re almost there, but there are barriers that we need to overcome.”

While examining previous research, the investigators found that using computer surveys to systematically collect patients’ symptoms was linked to less frequent emergency room admissions, longer average chemotherapy adherence, greater quality of life, and improved survival.

Despite these results, use of electronic reporting is not standard practice in health care. Basch argues that health care providers should be integrating patient-reported symptom information using a questionnaire patients fill out during or between physician visits. According to the investigators, the questionnaires could completed using the internet or smart devices, and then transmitted into electronic health records.

This approach would provide clinicians with automated notifications about any issues or concerning symptoms patients are having.

“There’s nothing earth-shattering here,” Basch said. “Patients already can call us when they have health concerns—–although often they are hesitant to call the office or can’t get through. What we want to do is switch this process over to an electronic format. It’s taking something we’ve been doing, and making it more efficient and systematic.”

Although this practice has proven health benefits, there are several obstacles preventing the system’s integration.

Major providers of electronic health records software have only a rudimentary ability to collect patient data, according to the study. Furthermore, software applications used to collect patient data are not widely used by patients.

“The companies that develop these electronic record systems have not been patient-centered in their approach, so it leaves the patient voice out,” Basch said. “Some of them have developed some patient portal applications, but they’re very clunky, and the vast majority of patients do not use them at this point.”

Additionally, there is a lack of strong financial incentive for medical providers to implement these systems for patient-reported outcomes, according to the study.

“These systems cost money to set up and to accommodate,” Basch said. “There needs to be a business model for doing that. It would save money, ultimately, because there would likely be fewer ER visits, and outcomes would improve. It would make sense to pay for this because it adds value.”

The last barrier are concerns with implementation. According to Basch, medical providers must find ways to efficiently incorporate monitoring of patient-reported symptoms into their regular work. Furthermore, there is a need for a standardized questionnaire for reporting symptoms.

“There is tremendous unnecessary suffering and unnecessary utilization of emergency services because we are not addressing patients’ problems between visits adequately,” Basch concluded. “This is just one mechanism for monitoring people, but it could help us turn patient-centered care into a reality.”