Identify Implementation Team
Implementation requires a multi-disciplinary team.
Multiple sites have found that an effective clinician champion is critical for implementation success (see Recommendations from Successful Implementations). Although little research identifies which aspects of this role are critical, some features include:
- Located within the clinic doing implementation
- Champions the value of patient-reported outcome measures for patient care with providers, staff, and institutional leadership
- Marshals resources for implementation (e.g., personnel, hardware and licensing fees)
- Defines objectives and sets priorities
- Leads or co-leads implementation efforts in clinic within multi-disciplinary team
- Responsible for performance
Institution-employed informaticists are needed to complete many tasks including:
- Technical build of administration platform
- Add selected patient-reported outcome measures
- Conduct end-to-end system test
- Configure tablets or kiosks for in-clinic assessment
- Support hardware and software when problems arise including creating a ticket support system if necessary
- Provide support for in-clinic connectivity issues
- Order data collection devices (e.g., tablets) and create an asset management model with an established product life cycle
- Perceives implementation of patient-reported outcomes as a priority.
- Commits resources for successful implementation.
Several roles are needed within a given clinic. One person may fill more than one role. Possible roles include:
- Implementation coordinator: leads implementation including identifying tasks, coordinating multi-disciplinary team, identifying required resources, establishing timelines, and ensuring a smooth rollout. May lead training and track participation over time.
- An operational leader knows clinic workflow and staff responsibilities and can guide how to alter workflow and responsibilities to enable patient-reported outcome implementation. The operational leader tracks metrics regarding patient and provider participation.
- Consider creating a Staff Champion to lead training, reiterate rationale for collection, and answer staff questions.
When implementation extends beyond a single clinic, some roles can move to the institution level and support multiple clinics. Possible roles include:
- Trainer: creates training materials and performs training.
- Implementation coordinator: when implementation extends beyond a single clinic, this role may move from the clinic level to the institutional level (e.g., oversees implementation across multiple clinics).
- Measurement scientist(s): provide expert guidance on patient-reported outcome measures to achieve clinic’s aims.
- Patient representatives: provide patient perspective on aspects of health to assess, how to communicate with patients, and how to make information relevant for patients among other topics.
When implementation of patient-reported outcomes is conducted across multiple clinics or an entire health system, a governance structure is needed. The ePROs in Clinical Care site, funded by the Agency for Healthcare Research and Quality (AHRQ), identifies multiple tasks for a governing body including:
- Aligning patient-reported outcome assessment aims with the healthcare system’s goals
- Identifying how IT infrastructure will be utilized
- Creating a process for evaluation, coordination, and prioritization of implementation for specific clinics
- Defining and monitoring implementation metrics,
This site provides downloadable tools such as:
- Sample governance charter
- Project intake checklist
- Implementation planning checklist
- Sample monitoring plan
Find these and more under Tools and Resources. Learn more>>
PCORI supported the creation of the Users’ Guide to Integrating Patient-Reported Outcomes in Electronic Health Records in 2017. It identifies multiple approaches to governance including:
- Distributed governance
- Centralized Governance
It also identifies options for membership including:
- Pre-existing governance body for electronic health record
- Patient representatives
- Broad group of stakeholders
A PDF of the presentation “How will the PRO-EHR system be governed?” is also available. Learn more>>