Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK.
NIHR Greater Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
J Am Med Inform Assoc. 2020 Nov 1;27(11):1752-1763. doi: 10.1093/jamia/ocaa177.
People with long-term conditions require serial clinical assessments. Digital patient-reported symptoms collected between visits can inform these, especially if integrated into electronic health records (EHRs) and clinical workflows. This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions.
We searched Medline, Web of Science, and Embase. Inclusion criteria were symptom reporting systems in adults with long-term conditions; data integrated into the EHR; data collection outside of clinic; data used in clinical care. We synthesized data thematically. Benefits were assessed against a list of outcome indicators. We critically appraised studies using the Mixed Methods Appraisal Tool.
We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based on the study results, and were only supported by evidence from early-stage qualitative studies. Studies were primarily feasibility and pilot studies of acceptable quality.
EHR-integrated remote symptom monitoring is possible, but there are few published efforts to inform development of these systems. Currently there is limited evidence that this improves care and outcomes, warranting future robust, quantitative studies of efficacy and effectiveness.
患有慢性病的人需要进行多次临床评估。在就诊期间之外收集的数字患者报告症状可以为这些评估提供信息，尤其是如果将这些症状整合到电子健康记录（EHR）和临床工作流程中。本系统评价确定并总结了远程收集患者报告症状的 EHR 整合系统，并研究了这些系统在慢性病中的预期和实际获益。
我们检索了 Medline、Web of Science 和 Embase。纳入标准为：针对患有慢性病的成年人的症状报告系统；数据整合到 EHR 中；在就诊之外收集数据；数据用于临床护理。我们通过主题对数据进行了综合分析。根据一系列结果指标评估了获益。我们使用混合方法评估工具对研究进行了批判性评估。
我们纳入了 12 项研究，代表了 10 个系统。其中 7 项研究涉及肿瘤学。系统在技术和功能上存在差异，其中大多数是完全集成的（数据可在 EHR 中查看）。有一半的系统能够在就诊期间定期跟踪症状。我们确定了 3 种基于症状报告的临床工作流程：仅咨询（数据在咨询期间使用，n=5）、基于警报（为提供者提供实时警报，n=4）和患者发起就诊（n=1）。根据研究结果，只有少数作者描述的预期获益（主要是改善沟通和由此产生的健康结果）得以实现，并且仅得到早期定性研究证据的支持。这些研究主要是可行性和初步研究，质量尚可。
EHR 整合的远程症状监测是可行的，但目前很少有研究致力于为这些系统的开发提供信息。目前，几乎没有证据表明这可以改善护理和结果，因此需要未来进行更有力的、关于疗效和有效性的定量研究。
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