Implementing Electronic Symptom Screening for Telehealth Visits (2020-2021)


Cancer survivors, and those living with the disease, experience a cadre of issues and symptoms that often go unrecognized or are inadequately addressed. Research shows that the collection and monitoring of patients’ symptoms using electronic Patient Reported Outcomes (ePROs) assessments can enhance care and lead to improved quality of life, prolonged survival and reduced resource utilization. The Duke Cancer Institute has successfully implemented ePRO assessments into routine in-person cancer care visits. 

The coronavirus pandemic has led to a rapid increase in telehealth visits, including for routine cancer care. At the same time, the pandemic has resulted in new unmet patient needs. There is currently no method for collecting and utilizing ePRO symptom screening data in the context of telehealth visit workflows to proactively identify and mitigate patients’ unmet symptoms and needs. Improved screening using ePRO tools is now more crucial than ever as clinicians aim to reduce unscheduled physician appointments, emergency department visits and hospitalizations – all of which are high-risk visits for cancer patients during the pandemic.

Project Description

Drawing on the prior process used by the Duke Cancer Institute when implementing the ePRO for in-person visits, this project team will develop a new workflow to integrate and assess the ePRO tool into telehealth visits at the Duke Cancer Institute. By integrating the ePRO assessment into telehealth visits, the team will have the opportunity to improve care for cancer patients and reduce riskier health visits. If proven successful, this model has the potential to scale to other parts of the health system. Specifically, this team will:

  1. Develop a new workflow to integrate ePRO into telehealth visits: Team members will develop nursing and clinician workflows pertaining to the collection, review and triage of ePRO information for telehealth cancer care visits. They will then test and implement a process for contacting patients who report bothersome symptoms (those at the moderate or severe level) to improve care between scheduled appointments
  2. Implement the new workflow and monitor for necessary process improvements: The team will partner with Duke Cancer Institute clinics to implement this novel telehealth ePRO approach as well as identify and implement needed process improvements.
  3. Assess use and effectiveness of the ePRO implementation: Team members will use data analytics to assess clinician utilization of ePROs prior to telehealth visits; interview staff and clinicians to assess their experiences with the eRPO implementation; and interview patients to collect feedback on their satisfaction and use of the ePRO as part of their telehealth visit.

Anticipated Outputs

Implementation of ePRO data collection as part of telehealth visit workflows; improved symptom assessment in patients with cancer; collection of rich patient experience data for more targeted treatment; enhanced quality of care; reduced downstream healthcare utilization; qualitative insights regarding participants’ experiences using ePROs as part of telehealth visits; research posters and manuscripts


Fall 2020 – Spring 2021

  • Fall 2020: Partner with DHTS to activate questionnaires sent through MyChart; develop timing algorithm to send ePRO via MyChart with telehealth appointments; automate distribution of questionnaires for clinicians performing telehealth; optimize physician workflow
  • Spring 2021: Analyze patient questionnaire completion rate; measure clinician satisfaction; measure proportion of physician notes that utilize symptom screener; measure patient satisfaction; analyze usage and satisfaction results to determine and inform optimization efforts; optimize analytics and workflow; develop final report


Image: With expanded options for telehealth, Duke doctors and patients can connect for virtual visits, by Duke Health/Duke Today


Team Leaders

  • Kris Herring, Duke Cancer Institute
  • Thomas Leblanc, School of Medicine-Medicine: Hematology

/graduate Team Members

  • Michael Tang, Interdisciplinary Data Science - Masters
  • Timothy Tsai, Mgt of Clinical Informations

/undergraduate Team Members

  • Laura Benzing, Biology (BS)
  • Alexander Hong
  • Alexandra Lawrence
  • Joshua Nidus
  • Reanna Shah
  • Augusto de Leon III, Biology (BS), Global Health (AB2)

/yfaculty/staff Team Members

  • Steven Wolf, School of Medicine-Biostatistics and Bioinformatics