Designing an Electronic Patient-Reported Outcomes Information Infrastructure Supported by the RE-AIM Implementation Framework

Authors

Amy C Moreno
Angela Peek
Toshiko S Stein
Kevin R Shook
Sara M Ali
Laia Humbert-Vidan
Aileen Chen
Miriam Lango
Anna Lee
Michael Spiotto
William H Morrison
Adam S Garden
Jack Phan
Steven J Frank
Katherine Hutcheson
David I Rosenthal
Clifton D Fuller
G Brandon Gunn

Language

English

Publication Date

9-1-2025

Journal

Advances in Cancer Education and Quality Improvement

DOI

10.52519/aceqi.25.1.2.a6

PMID

41624751

PMCID

PMC12854710

PubMedCentral® Posted Date

1-30-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Objective: Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (reach-effectiveness-adoption-implementation-maintenance) principles.

Materials and methods: We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were established and used to design patient, provider, and implementing facilitator information tools.

Results: From January 2021 to July 2024, our ePRO program has collected 13,156 patient-submitted ePROs on 3,497 unique HN patients, with a 12-month sustained ePRO compliance rate of 82%. We also propose a dynamic 2-cycle implementation model. This model can be used to continuously (re)define, build, and adapt ePRO information tools for patients, providers, and program facilitators.

Discussion: Our ePRO framework has several benefits, including integrated clinical data for enhanced decision-making, potential scalability, and use of a common EHR system. Formative (ie, mid-phase) evaluations were essential to our program, allowing for timely optimization of ePRO compliance, ePRO usage by clinical staff, and secondary use of high-quality ePRO data.

Conclusion: In this article, we provide a valuable roadmap toward developing a comprehensive, EHR-based ePRO information infrastructure simultaneously optimized for clinical utility, informatics operations, and implementation evaluation founded on RE-AIM principles.

Keywords

implementation research, information infrastructure, head and neck cancer, patient-reported outcomes, RE-AIM

Published Open-Access

yes

Recommended Citation

Moreno, Amy C; Peek, Angela; Stein, Toshiko S; et al., "Designing an Electronic Patient-Reported Outcomes Information Infrastructure Supported by the RE-AIM Implementation Framework" (2025). Faculty, Staff and Student Publications. 5655.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5655