Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design
Introduction: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients—physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT).
Methods: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery.
Findings: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs.
Conclusion: Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient care and quality improvement. Engaging health care professionals as stakeholders is a critical step toward the design of user-friendly HIT that is accepted, usable, and has the potential to enhance quality of care and patient outcomes.
Scoring, interpretation and display of results
Data Collection Tools/Healthcare Settings
PRO dashboards are designed to display PROs collected electronically from patients through the "CERTAIN Hub² within Washington state¹s patient-centered outcomes research initiative, the "Comparative Effectiveness Research and Translation Network². CERTAIN Hub is a web-based portal for improving patient data collection and for delivering programs aimed at improving health and healthcare. The Hub offers a patient portal for completing a baseline survey about current health status and automatic enrollment in follow-up surveys, and a clinician dashboard for reviewing patient-reported outcomes data.
Generalizability to other settings and best practices
Human-centered design, the approach we use, can be applied to other settings to understand the needs of health professionals and other stakeholder groups with interests in PROs. Lessons we learned about meeting the needs of health care professionals through health information technology (HIT) are reflected in our design recommendations for PRO Dashboard functionality for patient care (e.g., patient-level and provider-level views of data for panels of patients) and quality improvement (e.g., clinic-level views of aggregate data over time) contexts. These stakeholders provided further design considerations on content and interaction of user-friendly HIT as well as social and ethical considerations for data sharing. Examples include supporting custom-tailored ³snaposhots", interactive analytics with dynamic displays, integrating quality indicators, and developing privacy-preserving interfaces.Although engaging health care professionals as stakeholders is a critical step toward design of user-friendly HIT, our experience illustrates the need for new methods of effective engagement that respect the busy schedules of professionals.
Acknowledgement of Funders
We wish to thank PROs in Practice stakeholders who participated in this work. Special thanks is given to Andrew Buhayar and Henrik Holm Christensen for data collection, analysis and prototyping, Melissa Heckman for stakeholder engagement, and Amy Harper for project management. This work was supported by the National Library of Medicine Biomedical and Health Informatics Training Grant T15LM007442, the Agency for Healthcare Research and Quality Grant #R01HS020025, and the Washington State Life Sciences Discovery Fund Grant #4593311. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the Washington State Life Sciences Discovery Fund. The Surgical Care and Outcomes Assessment Program (SCOAP) is a Coordinated Quality Improvement Program of the Foundation for Health Care Quality. CERTAIN is a program of the University of Washington, the academic research and development partner of SCOAP.