Use of an electronic patient-reported outcome measurement system to improve distress management in oncology
This is a review of a 2014 article by Smith, Rowe, & Abernethy entitled; Use of an electronic patient-reported outcome measurement system to improve distress management in oncology.
The article mentions that psychological, behavioral, or social distress has been documented as a potential obstacle to a patient fully benefiting from health care. Starting in 2015, Cancer centers that seek to maintain accreditation by the United States Commission on Cancer would need to ensure that cancer patients (especially newly-diagnosed) receive distress screening and management. This is intended to enhance patient-centered care. Historical collection of patient outcomes using paper based forms was impractical (disrupted workflows), ineffective and costly- coupled with delays in the relay of pertinent patient findings to the clinical team for action. The authors discuss the implementation of an Electronic patient-reported outcome [ePRO] measurement system that is integrated into the routine clinical workflow and involves collaboration between the patient and the clinical team. 
The study was conducted at Duke University Medical Center. The ePRO process was used by patients and their physicians to capture cancer-related symptoms and psychosocial wellbeing. The system is reported to be user friendly and comprised of 4 parts as follows:
- 1) Software - called PACE which was developed by a group of oncologists.
- 2) Tablets - Wireless electronic tablets - available in each waiting room for patient use.
- 3) Analysis and Generation of reports - Color coded and visually appealing trend charts that were easy for patient to interpret.
- 4) Method for incorporating ePRO into routine care. 
Use of the ePRO survey tool allowed the clinical staff to effectively assess and manage patient distress in a timely fashion and triage patient care efficiently among multi-disciplinary teams. The clinicians were not only able to care for the entire patient's healthcare needs (including psychosocial) but were also able to reduce cost and eliminate time spent completing manual forms. A Phase 2 study was carried to routinely measure levels of distress in metastatic Breast Cancer patients over a period of 6 months. When used in conjunction with other instruments there were significant improvements observed in patient's quality of life, distress and dispair after about 3 months. 
The ePRO is an example of an Electronic data capture system that plays a role in EMR use to support Patient Centered Care. It can also be considered a form of a personal health record PHR. Although its use has been demonstrated in terms of clinical research, patient care and data management the data is not able to be electronically uploaded to the patient's EMR from the ePRO tool. There are also limitations as to the level of detailed distress information that the ePRO is able to capture. Future enhancements may include a web based ePRO system which could in turn facilitate increased clinical decision support. 
- Smith, S. K., Rowe, K., & Abernethy, A. P. (2014). Use of an electronic patient-reported outcome measurement system to improve distress management in oncology. Palliative & Supportive Care, 12(1), 69–73. doi:10.1017/S1478951513000345