My Wellness Check is a program that monitors patient-reported outcomes (PROs), such as psychosocial distress, physical symptoms, and psychosocial, practical, and nutrition needs in ambulatory oncology patients. These PROs and needs are assessed via the MyUHealth Chart portal and are scored and populated in real-time in the patient’s electronic health record.

The system assesses physical symptoms, psychosocial symptoms, nutrition needs, and practical needs.

A request to complete the assessment is sent via MyChart to adult patients with a cancer diagnosis 72 hours before their scheduled appointment. Best practice alerts (BPAs) automatically appear in EPIC for patients who endorse clinically elevated symptoms or report a need. Assessments are tied to appointments and take place no more than once every 30 days.

Relevant provider teams, such as social work, medical, and nutrition teams, are alerted in real-time via EPIC and asked to select a disposition based on the stated need or elevated score.

The Patient-Reported Outcomes Measurement Information System (PROMIS) is an NIH-funded initiative that has developed and validated patient-reported outcomes (PROs) for clinical research and practice. It includes a set of measures that evaluate and monitor physical, mental, and psychosocial health in adults and children. My Wellness Check uses PROMIS computerized assessment tests (CATs) to assess anxiety, depression, pain, fatigue, and physical function.

PROMIS Computer Adaptive Tests are brief, interactive assessment tools that tailor a person's questions depending on their responses. Scores within a specific range will trigger a best practice alert.

Yes. PROMIS CATs are brief, well-validated, and clinically relevant measures that can assess various PROs in cancer patients and survivors and provide actionable data to guide clinical practice.

Redundancy in several items is necessary to calculate the CAT score and establish a response pattern.

PROMIS CATs generate T-scores with clinically validated cutoffs based on normative data from cancer patients and the general population.

Data generated will be used to assist care providers in delivering precision and patient-centered care. My Wellness Check also meets accreditation requirements set by the American College of Surgeons, Commission on Cancer (COC) 2020 Standards, Section 5.2.

The single-item Distress Thermometer is a quick and easy tool but not always sufficient because it lacks sensitivity and specificity—it can yield a high rate of false positives or false negatives. The PROMIS tool provides greater accuracy in identifying relevant cancer-related distress.

My Wellness Check can provide metrics specific to patient’s distress, practical needs, and nutritional needs, thus assisting administrators in projecting and allocating necessary resources to meet the needs of our ambulatory oncology patients. The program also provides opportunities to optimize clinical workflows, evaluate how the identification of patients’ needs and appropriate referrals impact system-level outcomes, including care costs.

Contact the My Wellness Check team at MyWellnessCheck@med.miami.edu.

Yes. In the patient portal, patients can choose text messages as their preferred mode of communication from UHealth.

Since the My Wellness Check was designed as an electronic health record (EHR) integrated screening and referral model, it is recommended that a patient have a MyChart account to complete the screener. However, a patient without a MyChart account may complete My Wellness Check with the assistance of our clinic teams.

PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. Patients with PROMIS T-scores falling within 'moderate' or 'severe' thresholds will trigger an alert to the appropriate care team for triaging. In addition to physical and psychosocial symptoms, providers are also able to monitor and track a patient's practical and nutritional needs in the EHR over time.

Currently, My Wellness Check is a quality improvement project. However, once the program is implemented systemwide, research opportunities will be available (which will require IRB protocol submissions and approval) to assess the impact of the program at the patient- and system-level.

Garcia SF, Wortman K, Cella D, Wagner LI, Bass M, Kircher S, Pearman T, Penedo FJ. Implementing electronic health record-integrated screening of patient-reported symptoms and supportive care needs in a comprehensive cancer center. Cancer. 2019 Nov 15;125(22):4059-4068. doi: 10.1002/cncr.32172. Epub 2019 Aug 2. PMID: 31373682.

Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centered cancer care. Lancet Oncol. 2020 May;21(5):e240-e251. doi: 10.1016/S1470-2045(20)30021-8. PMID: 32359500.

Pearman T, Garcia S, Penedo F, Yanez B, Wagner L, Cella D. Implementation of distress screening in an oncology setting. J Community Support Oncol. 2015 Dec;13(12):423-8. doi: 10.12788/jcso.0198. PMID: 26863872.

A training guide and modules are available upon request by contacting Vandana Sookdeo, MD, Administrative Director of Clinical Programs, at v.sookdeo@med.miami.edu or MyWellnessCheck@med.miami.edu.

Contact Vandana Sookdeo, M.D., Administrative Director of Clinical Programs, at v.sookdeo@med.miami.edu or MyWellnessCheck@med.miami.edu.