Integrating Symptom Screening in Pediatrics Into the Epic Electronic Health Record: Development and Acceptability for Pediatric Cancer Patients

PURPOSE: Calls to implement routine symptom screening among pediatric oncology patients are increasing. Objectives were to develop and evaluate the usability of Symptom Screening in Pediatrics (SSPedi), a validated patient reported outcome tool, when integrated into the Epic electronic health record. METHODS: We developed self-report and proxy-report SSPedi in Epic's patient portal MyChart and enrolled patients with cancer age 12-18 years or their parent/guardians, and parents/guardians of patients with cancer age 2-18 years. Participants were enrolled in three cohorts of 10 participants per cohort. A clinical research associate evaluated the participants' ability to correctly complete eight tasks including finding and completing SSPedi on a scheduled day and when unscheduled, locating tips to manage symptoms, and viewing past SSPedi reports. Participants self-reported ease or difficulty in completing each task. Modifications were made to refine SSPedi in Epic after the enrollment of each cohort of 10 patients on the basis of feedback. RESULTS: We enrolled 30 participants, including 21 parents/guardians and nine patients. Overall, 60% were correctly able to find SSPedi on a scheduled reminder day and 33% were able to find SSPedi on an unscheduled day. Once found, 70% of participants could complete SSPedi correctly. Only 33% could correctly view SSPedi trends over time. By self-report, 20 of 30 participants (67%) found SSPedi easy or very easy to use overall. This increased to 100% in the final cohort of 10 participants. CONCLUSION: We integrated SSPedi into Epic. Participants can successfully complete SSPedi when scheduled on a reminder day. They found it more challenging to complete SSPedi without a reminder and to view past SSPedi reports. Implementation will require patient and parent/or guardian training and support.