This pilot study demonstrated that: (1) e/Tablets can collect data of comparable validity to data collected by well-recognized paper-based PRO surveys; and (2) e/Tablets are feasible and acceptable to patients in an academic oncology clinic. Data yielded by paper and electronic format of certain subscales—specifically, the FACT-G Social Well-Being subscale and all Self-Efficacy subscales—were not statistically equivalent and thus we cannot recommend interchangeability of these two data collection methods for these subscales. Potential reasons for paper versus electronic discrepancies on these subscales are explored elsewhere (Abernethy et al. 2007
e/Tablets functionally integrate the collection of clinical data and research data. They thus may exert a positive process impact; future studies might explore whether e/Tablets (or similar technology-based systems) enhance practice efficiency, support improved patient/provider communication, more expediently identify patient needs, and promote patient-centered care. In community oncology, the e/Tablet system has reduced dictation times, resulted in more accurate charting and billing, facilitated Joint Commission-compliant patient education, and enabled real-time quality monitoring (B. F., Fortner personal communication, August 2007). In academia, demonstration that e/Tablets can collect and longitudinally warehouse research-quality PROs, which can be efficiently matched with clinical trials, will be a strong motivator for their adoption. Linking clinical and research data with administrative data will cement their appeal to institutional leaders and administrators. Administrative data have been linked with e/Tablet data in community oncology; linkages at Duke are underway.
Patients today, through models such as consumer-directed health plans, are being asked to play an increasing role in medical decision making (Hibbard et al. 2004
). Patients' effectiveness in this role hinges upon “patient activation,” i.e. patients' acquisition of the skills, knowledge, and motivation to participate in their own health care (von Korff et al. 1997
). This pilot study suggests that e/Tablets may promote patient activation. Participants reported that e/Tablets helped them remember symptoms, and encouraged them to discuss medical issues with their doctor. At least one-third of participants felt that the e/Tablet enhanced the patient/physician dialogue. A study designed to more definitively evaluated e/Tablets' impact on patient activation might shed light on the technology's ability to facilitate patient activation. Current directions in software development, such as creation of Spanish and low-literacy versions, raise hopes that e/Tablets might help engage patients who are otherwise challenging to activate.
The data collection, integration, and storage capabilities of e/Tablets, and of similar validated technologies, could help advance initiatives designed to use PROs to enhance quality and value in health care. Nationally, the Patient Reported Outcomes Measures Information System (PROMIS), part of the NIH Roadmap, Re-engineering Clinical Research Initiative, is developing sophisticated methods of PRO collection, coordination, warehousing, and analysis. Internationally, countries such as Australia (Jackson 2007
), England (Walley 2007
), and Canada (Hailey 2007
) are using health technology assessment (HTA) to evaluate the effectiveness, costs, and broad impact of medical interventions; evaluations include patient-centered metrics such as quality-adjusted life years and health state.
e/Tablets represent a possible mechanism for gathering, storing, and making available for analysis the PRO data that will become part of large-scale health services research initiatives, and that will support the national effort to optimize efficiency and value in health care. Ultimately, the success of initiatives such as PROMIS and HTA may hinge on their ability to integrate data collected through many new technology-based systems into large-scale repositories that leverage the strengths of local clinical/research data collection and management systems in service of quality, integrity, efficiency, and value goals.
Several limitations of this e/Tablets study warrant noting. This was a pilot study conducted at a single institution; it enrolled a small convenience sample; participants comprised only women; all participants had the same disease.