Mixed-Methods User-Centered Design Evaluation of an Electronic Patient-Reported Outcome (ePRO) System to Enhance Post-Discharge Care for Thoracic Surgery Patients

Abstract

Purpose. Health information technology (HIT) tools intended to remotely monitor patients’ symptoms using electronic patient-reported outcomes (ePROs) can improve clinical outcomes; however, successful design requires meeting the unique needs of complex end-user groups. Therefore, we applied a user-centered design (UCD) approach to iteratively evaluate and inform improvements to an ePRO system designed for post-discharge thoracic surgery care, incorporating perspectives of patient, caregiver, and provider end-users. Methods. We purposively recruited a targeted sample of thoracic surgery patients, their caregivers, and providers to participate in field observations and semi-structured interviews; patients additionally completed the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) to assess usability. The research team synthesized data through iterative modeling, which was subsequently validated through a mixed end-user focus group. Data were analyzed using descriptive statistics and thematic content analysis guided by the Systems Approach to Health Care Delivery (SAHCD) and Lean Six Sigma 6Ms frameworks. Results. A total of 16 end-users participated, including patients (n=4), caregivers (n=2), and ten providers representing distinct segmented user groups of nurses (n=4) and surgeons (n=6). Emergent themes centered on user expectations, personalization, relationships, communication, and accessibility. Participants also highlighted the survey’s brevity, responsiveness of the care team, opportunities to strengthen patient and provider training, the need for clearer communication regarding ePRO use, and preferences for more contextualized alerts. Findings informed specific recommendations for system optimization. Conclusion. The UCD approach generated rich insights into end-user experiences, expectations, and interactions with the ePRO system. Future design efforts should focus on improvements that better support the diverse needs, workflows, and contexts of complex end-users.