Optimizing Cancer Pain Management Through an EHR Integrated Mobile Health Tool
Pain is among the most common and feared symptoms of cancer, affecting over two-thirds of patients with advanced disease. Pain takes a major toll on patients’ quality of life and is a leading cause of emergency department visits and hospitalizations. Managing cancer pain is complex and stressful for patients who are often given multiple opioid and non-opioid analgesics, which provide unpredictable relief and cause bothersome side effects. Patients largely learn to self-manage by trial and error and receive little education or structured support from cancer care teams. Although opioids require close monitoring and frequent dose titration, there is a lack of existing tools to allow care teams to proactively monitor and support patients.
With the generous support of The Fund for Innovation in Cancer Informatics over the past two years, our team has developed a novel EHR-integrated mobile health intervention, MyPainPal, to support advanced cancer patients and care teams in pain management. MyPainPal is a symptom solution platform with a connected mobile app and web portal. The patient-facing mobile app hosts patients’ analgesics and laxatives (for opioid-induced constipation), features a wide array of patient-centered multimedia content supporting pharmacologic and behavioral self-management, pushes surveys that track symptoms and medication use, and organizes patient responses in a symptom tracker. The connected, HIPAA-compliant clinician and study team portal facilitates monitoring and proactive outreach.
In the mobile app, patients are able to complete recall-based symptom assessments on a biweekly basis, reporting on pain levels, pain interference, medication use, and constipation severity. The platform also provides on-demand reporting in the form of a ‘Symptom Notebook’ where patients can log symptoms and medication use in real-time.
In clinician focus groups, we found them to be highly supportive of a digital symptom tool designed to aid patient and care team communication. Their involvement and feedback shaped the clinician portal design, particularly the patient symptom report displays. Patient interviews drove the development of new content, including the Symptom Notebook sections and symptom tracker displays. Patient wireframe interviews further refined the symptom solution.
While the MyPainPal platform is fully functional, the EHR integration remains in progress as we had to transition technical development vendors. The team has developed an API based web service to extract, filter, and tag supportive care medications from the Epic EHR. This work was done using standard APIs and medication codes (FHIR R4 APIs and RxNorm codes), enabling our integration approach to be easily replicated across different EHRs. Our new technical partners are now connecting our Epic-based webservice to the MyPainPal portal and building frontend capabilities to enable medication notifications and reconciliation. Our next step is to conduct a 10-patient usability pilot, and we will provide an update with these results. Our team is planning for a randomized pilot study of MyPainPal to support cancer patients hospitalized with pain, to support hospital-to-home care transitions.