. 2021 Apr 2;28(5):1051–1056. doi: 10.1093/jamia/ocab017

Table 1.

PROs and mHealth and their association with burnout

PGHD Domain	Definition	Association With Burnout
PROs	PROs are assessments of patients’ health conditions reported directly from patients in the form of questionnaires.⁷ Health-related outcomes reported by patients have higher accuracy than clinical reports.⁸ Patient reporting can improve patient–provider communication, patient satisfaction, and symptom management.⁹^,¹⁰ Widespread adoptions of PROs in performance evaluation cater to the growing interests in integrating PROs into EHR systems and patient portals.¹¹	Main barriers to integrating PROs data into EHR: 1. Work overload. Clinicians are concerned that adding PROs will make their work burdensome¹²; 2. Lack of actionable guidance¹³; 3. Lack of validity of PRO scores to sufficiently support clinical decision-making; 4. Lack of financial incentives. Clinicians have no motivation to increase their job responsibilities without improved payment models¹⁴; 5. Low level of engagement of patients in completing PRO assessment. Providers have to spend extra time to explaining the purpose and assisting patients in completing the tasks.¹³
mHealth	Mobile apps and wearable or portable devices that could be connected with smartphones have been increasingly harnessed to support health monitoring and management.¹⁵ Healthcare systems have been interdependent on EHR capacities due to the widespread adoption and legislation of meaningful use.¹⁶ Integration of data generated by various devices into EHR becomes a novel and critical capacity of hospital information systems.	Main barriers to integrating mHealth data into EHR: 1. Wearable device data are too noisy to be useful before compilation and interpretation by HCPs¹⁷; 2. HCPs may experience more alert fatigues in the clinical support systems¹⁸; 3. While some health systems and vendors have begun to develop user-centered design approaches to adapt workflows and collaborate with third-party wearable devices to improve the integration of PGHD and EHR, data interoperability and visualization still impede the connection between wearable PGHD and EHRs.¹⁹

PGHD Domain

Definition

Association With Burnout

PROs

PROs are assessments of patients’ health conditions reported directly from patients in the form of questionnaires.⁷
Health-related outcomes reported by patients have higher accuracy than clinical reports.⁸
Patient reporting can improve patient–provider communication, patient satisfaction, and symptom management.⁹^,¹⁰
Widespread adoptions of PROs in performance evaluation cater to the growing interests in integrating PROs into EHR systems and patient portals.¹¹

Main barriers to integrating PROs data into EHR:

1. Work overload. Clinicians are concerned that adding PROs will make their work burdensome¹²;

2. Lack of actionable guidance¹³;

3. Lack of validity of PRO scores to sufficiently support clinical decision-making;

4. Lack of financial incentives. Clinicians have no motivation to increase their job responsibilities without improved payment models¹⁴;

5. Low level of engagement of patients in completing PRO assessment. Providers have to spend extra time to explaining the purpose and assisting patients in completing the tasks.¹³

mHealth

Mobile apps and wearable or portable devices that could be connected with smartphones have been increasingly harnessed to support health monitoring and management.¹⁵
Healthcare systems have been interdependent on EHR capacities due to the widespread adoption and legislation of meaningful use.¹⁶
Integration of data generated by various devices into EHR becomes a novel and critical capacity of hospital information systems.

Main barriers to integrating mHealth data into EHR:

1. Wearable device data are too noisy to be useful before compilation and interpretation by HCPs¹⁷;

2. HCPs may experience more alert fatigues in the clinical support systems¹⁸;

3. While some health systems and vendors have begun to develop user-centered design approaches to adapt workflows and collaborate with third-party wearable devices to improve the integration of PGHD and EHR, data interoperability and visualization still impede the connection between wearable PGHD and EHRs.¹⁹

EHR: electronic health record; mHealth: mobile health; PGHD: patient-generated health data; PRO: patient-reported outcome.