Abstract

Objective

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.

Materials and Methods

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.

Results

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.

Discussion and Conclusions

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.

中文翻译：

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远程症状监测已集成到电子病历中：系统审查。

摘要

目的

有长期病情的人需要进行系列临床评估。两次就诊之间收集的患者报告的数字症状可以为您提供这些信息，尤其是如果将其集成到电子健康记录（EHR）和临床工作流程中。这项系统的审查确定并总结了EHR集成系统，以远程收集患者报告的症状，并检查了其在长期条件下的预期和实际收益。

材料和方法

我们搜索了Medline，Web of Science和Embase。纳入标准为长期病情成人的症状报告系统；数据整合到电子病历中；诊所外的数据收集；临床护理中使用的数据。我们按主题合成了数据。根据结果​​指标清单评估收益。我们使用混合方法评估工具对研究进行了严格评估。

结果

我们纳入了代表10个系统的12项研究。七位在肿瘤科。系统在技术和功能上是异构的，大多数系统已完全集成（可在EHR中查看数据）。一半的系统启用了两次访问之间的常规症状跟踪。我们确定了3种以症状报告为指导的临床工作流程：仅咨询（咨询期间使用的数据，n = 5），基于警报的（针对提供者的实时警报，n = 4）和患者发起的就诊（n = 1）。在研究结果的基础上，很少有作者描述的主要用于改善沟通和最终健康结果的预期收益得以实现，并且仅得到早期定性研究的证据支持。研究主要是可行性和可接受质量的中试研究。

讨论和结论

集成了EHR的远程症状监测是可能的，但是很少有公开的工作来告知这些系统的开发。目前，仅有有限的证据表明，这种方法可以改善护理和治疗效果，需要对疗效和有效性进行可靠的定量研究。