Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record

The objective of this research was to assess the implementation of collecting patient-reported outcomes data in the outpatient clinics of a large academic hospital and identify potential barriers and solutions to such an implementation. Three PROMIS computer adaptive test instruments, (1) physical function, (2) pain interference, and (3) depression, were administered at 23,813 patient encounters using a novel software platform on tablet computers. The average time to complete was 3.50 +/- 3.12 min, with a median time of 2.60 min. Registration times for new patients did not change significantly, 6.87 +/- 3.34 to 7.19 +/- 2.69 min. Registration times increased for follow-up (p = .007) from 2.94 +/- 1.57 (p < .01) min to 3.32 +/- 1.78 min. This is an effective implementation strategy to collect patient-reported outcomes and directly import the results into the electronic medical record in real time for use during the clinical visit.