377Smartphones also support mobile medical and public health practice and give
great opportunities [ 57 , 60 ]. Apps offer new forms of patient (self-)management
[ 61 ]. For example, free-of-charge electronic diaries including ePROMs were devel-
oped for different devices (e.g., smartphones, tablet PCs) as well as for different
operating systems (such as iOS, Android, and Windows) [ 62 ]. They allow remote
ePROM documentation whenever wanted and in even more asynchrony with their
patient visit to the caring physician and might lead to a fundamental change in
patient–physician interaction and directly infl uence therapy [ 62 ]. Azevedo et al.
give a current overview on smartphone apps for self-management of rheumatic dis-
eases and related problems that at least partly include ePROMs [ 57 ].
Physical disability as a sequel of chronic rheumatic diseases might be considered
as a handicap for the use of mobile devices. Nevertheless, RA patients use elec-
tronic diaries and self-report their symptoms, major restrictions were not yet
reported [ 61 – 63 ]. Compliance with computerized diaries is said to be much higher
than the compliance with paper diaries, and additionally computerized PRO assess-
ment can increase patients’ compliance [ 50 , 64 , 65 ].
Website-based systems permit the gathering of ePROMs [ 5 , 49 ]. For example, the
international METEOR Project ( http://www.meteorfoundation.com/ ) developed a Web
tool that allows registered user-restricted online documentation of PROs, physician-
derived parameters, and an online access for patients to look in their electronic patient
record [ 66 ]. Koevots et al. reported a high interest in online self-surveillance of the
disease [ 67 ]. Although less than half of the patients used the system in their feasibility
and acceptability study, the authors conclude that an autonomous online registry is
feasible in daily clinical practice [ 67 ]. As a prerequisite for online data acquisition a
cross-sectional study including ePROMs performed via a Web-portal showed that data
assessed online is equivalent to paper-based data [ 68 , 69 ]. As an initial example of a
new approach to tight-control concepts, Walter et al. evaluated whether tightly con-
trolled disease activity is possible with provided online PROMs [ 70 ].
However, collected ePROMs might be useless without being reviewed by physi-
cians or other staff members. Thus, whenever ePROMs are incorporated in the care
process, data should be shown to the physician during regular personal consulta-
tions. Alternatively, secure data transfer and exchange as well as remote reviewing
should be provided to the stakeholders. Further researc h on the development and
evaluation of applications are warranted [ 57 , 59 ]. This includes remote ePROM
documentation via apps integrated into the popular treat-to-target strategies and
other new care management concepts. Other disciplines already have described that
apps might improve treatment accessibility [ 59 ].
Concrete Examples of ePROMs Evaluation
Several studies have been performed on the large armam entarium of ePROMs
available not only in rheumatology but also in other disciplines, such as cancer and
neurology, that use similar PROMs as rheumatologists [ 41 , 71 , 72 ].
15 Electronic Patient-Reported Outcome Measures (ePROMs) in Rheumatology