113other uses for those data. This represents another new evolving role for PROMs,
which can facilitate incorporating information on HRQOL and quality of life in
treatment decision-making of RA patients, improving the relevance of the QALY as
a composite measure to those groups of users. Data derived from a PROMs question-
naire should provide the guide for the treating clinician in making decisions about
different clinical inputs as well as for monitoring the outcomes and response to treat-
ment. By implementing PROMs routinely in standard clinical practice, it can help to
set up a management plan tailored to the patient’s needs. In addition to its value in
providing a baseline assessment of the health status, quality of life, and patient satis-
faction or well-being, it helps to improve the patient physician communication, iden-
tifying new comorbidities that might have developed over the past few months prior
to the clinic visit and the assessment of different procedure effectiveness.
Electronic Patient-Reported Outcome Measures
in Rheumatoid Arthritis
Electronic health recording started to have its place in standard rheumatology
practice. Direct provision of patient-reported outcomes via standardized electronic
questionnaires was suggested as a tool to improve the effi ciency, completeness, and
accuracy of data collection. This overall approach is consistent with a broader
movement in the healthcare delivery toward a patient-centered approach, quality of
care provided, as well as the functioning of electronic health recording. For several
years, a key barrier to the use of ePROMs data in clinical care settings was the dif-
fi culty of transforming the paper-based questionnaires into an instantly accessible
application [ 83 ]. With the rapid expansion of Internet-connected gadgets and mobile
devices, both at home and in the clinical setting, it became possible to develop
online systems with a broad range of implementations in standard clinical practice.
However, it has to be noted that an ePROMs system does not replace the patient–
clinician clinical assessment and discussion, but it helps to focus the dialogue on
symptoms that need consideration and allow the clinician to quickly determine
whether the patient’s symptoms are worsening or improving over time, therefore it
has a time saving impact on clinic visits.
Earlier reports raised the concern that paper-based questionnaires might need to
be altered to be presented in electronic formats. As this could change the way
patients respond to the questions, PROMs methodologists have outlined the reasons
and approaches for evaluating the equivalence of the questionnaire data across each
mode of administration [ 84 ]. Earlier studies carried out in oncology clinical practice
[ 85 – 87 ] revealed that these smart electronic systems supported multiple clinical
activities, including assessment of symptoms and toxicities related to chemotherapy
and radiation, postoperative surveillance, and symptom management during pallia-
tive care and hospice. A recent study [ 88 ] was carried out to assess the use of
electronic patient-reported outcome measures in the standard clinical care setting of
early arthritis patients. Results revealed that an ePROMs questionnaire could be
4 PROMs for Rheumatoid Arthritis