Implementation of scalable ePRO monitoring in oncology care delivery: Operational impact and workforce redesign.

Abstract

498 Background: Electronic patient-reported outcomes (ePROs) enable earlier identification of treatment-related symptoms in oncology, but implementation at scale introduces workflow and operational challenges. Less is known about how large-scale ePRO integration reshapes care delivery models, nursing workflows, and workforce requirements in oncology practice. Methods: A retrospective quality improvement analysis was conducted following deployment of the Canopy care management platform across a statewide oncology program. Outcomes included ePRO utilization, symptom-triggered triage activity, nurse interventions, escalation patterns, and workflow changes. Pre- and post-implementation ePRO volumes and operational performance metrics were compared. Results: Following implementation, average weekly ePRO submissions increased from 699 to 10,708 across the organization. Of these, 22% were automatically resolved without nurse intervention due to the absence of reported symptoms, distress, or refill needs, while 78% required nursing review and clinical support. Median resolution time was 50 minutes, remaining well below the 70-minute benchmark despite substantial volume growth. The increase in symptom-triggered alerts resulted in a marked rise in nurse-led triage activity and clinical interventions, including symptom assessment, medication management, provider escalation, and supportive care coordination. To sustain operational performance at scale, the triage team of approximately 85 nurses expanded by an additional 16 nurses. Representative cases demonstrated earlier identification and intervention for worsening symptoms, creating opportunities to prevent potential clinical deterioration. Conclusions: Implementation of scalable ePRO monitoring significantly increased symptom detection, patient engagement, and nurse-led clinical intervention while maintaining efficient resolution times. This growth was achieved with a 1432% increase in ePRO volume supported by only a 19% increase in triage staffing, highlighting the efficiency and scalability of this care model. Beyond functioning as a clinical tool, ePRO integration redefines oncology care delivery by shifting toward proactive, technology-enabled care models that require intentional workforce and infrastructure alignment. These findings highlight the transformative impact of digital symptom monitoring on oncology care delivery, while underscoring the workforce and infrastructure investments required to support scalable, proactive symptom management.