379patients [ 75 ]. Newman et al. successfully developed a touchscreen questionnaire
and a Web-based dashboard (Patient Centric Electronic Redesign [PACER]) for the
collection, scoring, storing, and presentation of PROs at the point of care [ 76 ].
Recently, again BASFI, BASDAI, and the Ankylosing Spondylitis Disease Activity
Score assessment in a touchscreen system was feasible, well accepted by patients,
and showed good data quality, reliability, and score agreement [ 77 ].
Although kids are nowadays digital natives, reports for pediatric rheumatology
are scarce [ 78 ]. Having implemented and positively evaluated a Web-based applica-
tion to monitor quality of life-related problems in pediatric rheumatology, the
authors recommend implementation of ePROs in pediatric clinical practice [ 78 ].
Meanwhile, ePROMs in apps used on smartphones have been evaluated: Toruos
et al. showed that patients with depressive disorders are able to use the Patient
Health Questionnaire-9 (PHQ-9) in an app on their personal smartphones to self-
assess their symptoms of depression and that app scores strongly correlated with
traditionally administered PHQ-9 scores [ 63 ]. Recently, Richter et al. compared RA
patients’ mobile data entry of a set of PROs (FFbH/HAQ, RADAI) using an app on
a smartphone to paper–pencil versions. The authors demonstrated that patients are
able to complete ePROMs in a mobile medical app (mApp) on a smartphone and
that scores obtained by patients direct data entry on the smartphone did not differ
signifi cantly from the paper–pencil scores [ 79 ]. Strengths and weaknesses of apps
and mobile health in the routine rheumatology service have been summarized by El
Miedany [ 80 ].
ePROMs in Telemedicine Applications
Telemedicine bridges a spatial distance and involves information technologies such
as interactive audio and video communications, email, smartphone, and other forms
of telecommunications technology [ 81 ]. Telemedicine respectively telemonitoring
applications are complex innovations offering many evaluated opportunities: They
showed positive effects on hospitalization, quality of life, and costs in other chronic
diseases [ 82 , 83 ]. Telemedicine developments are regarded as a healthcare alterna-
tive for patient remote monitoring even in more rural areas [ 84 – 86 ].
In 2012 “telerheumatology” was promoted as a solution to the national shortage
of rheumatologists in Australia, which might serve as a model for other regions with
shortages in manpower [ 85 ]. Additionally, a telemonitoring approach to self-
managed kinesiotherapy sessions for the rehabilitation of hand function in patients
with systemic sclerosis and RA has been evaluated positively [ 87 ]. In fi bromyalgia,
Salaffi et al. assessed an Internet-based home telemedical surveillance system. The
system effectively evaluated pain and other health outcomes. The authors concluded
that telemonitoring proved to be an easy to-use solution for patient-centered data
acquisition [ 88 ]. From the patients’ perspective, preliminary quality attributes impor-
tant to telemedicine encounters have been published [ 89 ]. This underlines that tele-
medicine might provide further possibilities, but still needs further evaluation [ 82 ].
15 Electronic Patient-Reported Outcome Measures (ePROMs) in Rheumatology