The Current Landscape for Remote Digital Symptom Monitoring with Patient-Reported Outcomes during Cancer Care
Multiple clinical trials and population studies have demonstrated benefits of remote digital symptom monitoring using patient-reported outcomes (PROs) during systemic cancer therapy, including impro-vements in symptom control, quality of life, physical function, emergency room visits and hospitaliza-tions, and overall survival (1-11) Digital symptom monitoring generally involves software that prompts patients to self-report their symptoms on a regular basis via a survey (e.g., weekly), using a computer or connected device (Figure 1). Severe or worsening symptoms trigger electronic alert notifications to the care team to react and manage concerning symptoms.
Based on this evidence, implementation of remote digital symptom monitoring programs has com-menced in many health systems and oncology practices internationally. However, this field is still in the early adoption stage. Widely accepted standards have not been established yet, and there is not a uniform approach for financial support of these programs.
mplementation of digital symptom monitoring requires selection of a software system, decisions on which symptom questions to include, training patients, monitoring patient compliance, allocating ad-ministrative staff time to train patients, and allocating clinical staff time to receive and react to alert notifications (12, 13). On average, about 30% of surveys will trigger an alert notification, so for a clinical staff member managing a panel of 100 patients, there will be up to 30 alert notifications each time all patients self-report. Nonetheless, these programs have been found to be cost-eff ective (14).In the United States, progress with implementation has been made in the past five years. The major electronic health record vendors have developed digital symptom monitoring PRO functionality either native to their software or through partnerships with PRO software companies. Implementation has occurred in multiple oncology practices nationally, with attention to challenges and solutions to successful rollout (15).However, widespread adoption has been limited by the lack of a consistent financial support model from governmental or private payers. It is clear that successful implemen-tation requires expenses to practices related to staff time and technology. Without clear sources of financial support, adequate resources for successful and durable implementation are limited.
Implementation of digital symptom monitoring requires selection of a software system, decisions on which symptom questions to include, training patients, monitoring patient compliance, allocating ad-ministrative staff time to train patients, and allocating clinical staff time to receive and react to alert notifications (12, 13). On average, about 30% of surveys will trigger an alert notification, so for a clinical staff member managing a panel of 100 patients, there will be up to 30 alert notifications each time all patients self-report. Nonetheless, these programs have been found to be cost-eff ective (14).In the United States, progress with implementation has been made in the past five years. The major electronic health record vendors have developed digital symptom monitoring PRO functionality either native to their software or through partnerships with PRO software companies. Implementation has occurred in multiple oncology practices nationally, with attention to challenges and solutions to successful rollout (15).However, widespread adoption has been limited by the lack of a consistent financial support model from governmental or private payers. It is clear that successful implemen-tation requires expenses to practices related to staff time and technology. Without clear sources of financial support, adequate resources for successful and durable implementation are limited.
Recently, sources of payment to support digital symptom monitoring have evolved in the United States (16). For example, this year, the U.S. Centers for Medicare & Medicaid Services (CMS) announced a new payment model for oncology called the Enhancing Oncology Model, which requires oncology clinics to implement symptom monitoring with PROs (https://www.cms.gov/newsroom/fact-sheets/enhancing-oncology-model).
This lays a path for payments to practices for supporting digital symptom monitoring programs. However, this is a voluntary payment model, so not all practices will participate. An additional mechanism for financial reimbursement to practices is within new CMS billing codes for “Remote Therapeutic Monitoring” and “Remote Patient Monitoring”. These codes provide payments to practices for training and monitoring activities by clinical staff related to remote monitoring technologies. However, there some technical limitations of these codes that will likely be worked out in the next 1-2 years to make them fit better with current models of digital symptom monitoring in oncology (15).
In summary, there have been multiple implementation eff orts in U.S. oncology practices for remote symptom monitoring using PROs. Widespread adoption has been limited in the past by lack of a consistent financial model for supporting related practice expenses. New payment initiatives from CMS in the U.S. provide a promising path forward towards broader implementation.
Figure 1.
Clinical workfl ow for digital symptom monitoring with patient-reported outcomes (reproduced with permission from E. Basch)
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Pr Ethan BASCHMD
Division of Oncology,
University of North Carolina,
Chapel Hill, NC USA
Article paru dans la revue « Société Française des Jeunes Radiothérapeutes Oncologues » / SFjRO n°03
