{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T20:21:34Z","timestamp":1774729294669,"version":"3.50.1"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Agency for Healthcare Research and Quality\u2019s","award":["233-2015-000221-4"],"award-info":[{"award-number":["233-2015-000221-4"]}]},{"name":"Office of the Secretary Patient-Centered Outcomes Research Trust Fund under Interagency","award":["HP-17-003"],"award-info":[{"award-number":["HP-17-003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Despite a proliferation of applications (apps) to conveniently collect patient-reported outcomes (PROs) from patients, PRO data are yet to be seamlessly integrated with electronic health records (EHRs) in a way that improves interoperability and scalability. We applied the newly created PRO standards from the Office of the National Coordinator for Health Information Technology to facilitate the collection and integration of standardized PRO data. A novel multitiered architecture was created to enable seamless integration of PRO data via Substitutable Medical Apps and Reusable Technologies on Fast Healthcare Interoperability Resources apps and scaled to different EHR platforms in multiple ambulatory settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We used a standards-based approach to deploy 2 apps that source and surface PRO data in real-time for provider use within the EHR and which rely on PRO assessments from an external center to streamline app and EHR integration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The apps were developed to enable patients to answer validated assessments (eg, a Patient-Reported Outcomes Measurement Information System including using a Computer Adaptive Test format). Both apps were developed to populate the EHR in real time using the Health Level Seven FHIR standard allowing providers to view patients\u2019 data during the clinical encounter. The process of implementing this architecture with 2 different apps across 18 ambulatory care sites and 3 different EHR platforms is described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our approach and solution proved feasible, secure, and time- and resource-efficient. We offer actionable guidance for this technology to be scaled and adapted to promote adoption in diverse ambulatory care settings and across different EHRs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocab110","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T12:05:38Z","timestamp":1622117138000},"page":"2220-2225","source":"Crossref","is-referenced-by-count":20,"title":["A novel application of SMART on FHIR architecture for interoperable and scalable integration of patient-reported outcome data with electronic health records"],"prefix":"10.1093","volume":"28","author":[{"given":"Deliya B","family":"Wesley","sequence":"first","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"Georgetown University School of Medicine, Washington, District of Columbia, USA"}]},{"given":"Joseph","family":"Blumenthal","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"MedStar National Center for Human Factors in Healthcare, Washington, District of Columbia, USA"}]},{"given":"Shrenikkumar","family":"Shah","sequence":"additional","affiliation":[{"name":"MedStar Institute for Innovation, Washington, District of Columbia, USA, and"}]},{"given":"Robin A","family":"Littlejohn","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"MedStar National Center for Human Factors in Healthcare, Washington, District of Columbia, USA"}]},{"given":"Zoe","family":"Pruitt","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"MedStar National Center for Human Factors in Healthcare, Washington, District of Columbia, USA"}]},{"given":"Ram","family":"Dixit","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"MedStar National Center for Human Factors in Healthcare, Washington, District of Columbia, USA"}]},{"given":"Chun-Ju","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Division of Digital Healthcare Research, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA"}]},{"given":"Christine","family":"Dymek","sequence":"additional","affiliation":[{"name":"Division of Digital Healthcare Research, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA"}]},{"given":"Raj M","family":"Ratwani","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland, USA"},{"name":"Georgetown University School of Medicine, Washington, District of Columbia, USA"},{"name":"MedStar National Center for Human Factors in Healthcare, Washington, District of Columbia, USA"}]}],"member":"286","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"issue":"4","key":"2021091817523395900_ocab110-B1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/2229-3485.86879","article-title":"Patient-reported outcomes: a new era in clinical research","volume":"2","author":"Deshpande","year":"2011","journal-title":"Perspect Clin Res"},{"issue":"4","key":"2021091817523395900_ocab110-B2","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s40271-014-0090-z","article-title":"Capturing patient-reported outcome (PRO) data electronically: the past, present, and promise of ePRO measurement in clinical trials","volume":"8","author":"Coons","year":"2015","journal-title":"Patient"},{"issue":"jan28 1","key":"2021091817523395900_ocab110-B3","doi-asserted-by":"crossref","first-page":"f167","DOI":"10.1136\/bmj.f167","article-title":"Patient reported outcome measures could help transform healthcare","volume":"346","author":"Black","year":"2013","journal-title":"BMJ"},{"issue":"4","key":"2021091817523395900_ocab110-B4","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1377\/hlthaff.2015.1362","article-title":"Incorporating patient-reported outcomes into health care to engage patients and enhance care","volume":"35","author":"Lavallee","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"2021091817523395900_ocab110-B5","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s11136-007-9295-0","article-title":"The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature","volume":"17","author":"Valderas","year":"2008","journal-title":"Qual Life Res"},{"issue":"2","key":"2021091817523395900_ocab110-B6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/MLR.0000000000000289","article-title":"The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care","volume":"53","author":"Jensen","year":"2015","journal-title":"Med Care"},{"key":"2021091817523395900_ocab110-B7"},{"issue":"5","key":"2021091817523395900_ocab110-B8","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1093\/jamia\/ocv189","article-title":"SMART on FHIR: a standards-based, interoperable apps platform for electronic health records","volume":"23","author":"Mandel","year":"2016","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2021091817523395900_ocab110-B9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.13063\/2327-9214.1015","article-title":"Advances in patient reported outcomes: The NIH PROMIS measures","volume":"1","author":"Broderick","year":"2013","journal-title":"EGEMS"}],"container-title":["Journal of the American Medical Informatics 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