Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 14, 2024
Date Accepted: Jan 16, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Real-World Experience of Integrating Patient-Reported Outcomes into Electronic Hospital Records Using a Mobile Messaging App in Patients Undergoing Radiation Treatment for Breast Cancer: A Cross-Sectional Retrospective Study
ABSTRACT
Background:
Integrating electronic patient-reported outcomes (ePRO) into electronic health records (EHR) can enhance cancer care. However, effective integration remains challenging, especially in real-world settings.
Objective:
This study aims to evaluate the effectiveness of integrating ePRO into EHR using a mobile messaging app for patients with breast cancer.
Methods:
We conducted a retrospective analysis of prospectively collected ePRO data using the Breast-Q questionnaire from breast cancer patients who received adjuvant radiotherapy (RT) at our institution between May 2023 and April 2024. During the study period, each patient encountered ePRO requests one to three times according to their scheduled hospital visits before and after RT. Our ePRO system delivered questionnaires through the app, with responses automatically integrated into the EHR. Response rate was calculated as the percentage of patients whose responses were successfully recorded in the EHR among those asked to respond. Complete response (CR) was defined
Results:
A total of 1,488 patients’ data were analyzed, including 2,431 encounters (median of one encounter per patient). The CR rate across the first to the third ePRO encounter was 89.9%, 98.3%, and 97.3%, respectively. Younger patients had a significantly higher CR rate (90.9% in patients < 60 years vs. 87.0% in patients ≥ 60 years, p = 0.03). The timing of questionnaire dispatch also influenced CR, with higher rates observed when questionnaires were sent more than one hour before the visit (93.3%) or in the afternoon of the previous day (92.7%) compared to other timings, which were approximately 80% (p < 0.01). Both factors of age and the timing remained significant in multivariate analysis (both, p < 0.01).
Conclusions:
This study demonstrates that integrating ePRO into EHR through the app is feasible and shows high patient adherence. Factors including age and timing of questionnaire requests influence ePRO response rates. These findings provide insights for optimizing ePRO systems in clinical oncology practice.
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