Real-world implementation of eSyM: An electronic health record-integrated patient reported outcomes management program in a community-based oncology network.

583 Background: Electronic patient reported outcomes (ePROs) with proactive symptom management improves clinical outcomes and reduces cost of care for cancer patients. eSyM, an ePRO tool to assess symptoms was designed by the SIMPRO consortium including Maine Health Cancer Care (MHCC) and was piloted in limited cancer disease sites starting in 2019. MHCC is a community-based network of nine cancer centers in rural Maine and New Hampshire. Methods: In June 2024, MHCC expanded eSyM eligibility criteria to include all cancer patients receiving systemic therapy as part of routine care. ICD-10 codes were uploaded into the eSyM registry for patient identification. Training materials for patient and staff education were created. Patients receive NCI-PRO-CTCAE based eSyM questionnaires through MyChart at baseline and during successive cycles of chemotherapy. Patient reported symptoms are triaged based on severity. An eSyM dashboard using the power BI platform (Microsoft Corporation, Redmond, WA) allowed monitoring of eSyM adoption and impact of eSyM use on emergency department (ED) visits and hospitalizations. National Comprehensive Cancer Network (NCCN) distress thermometer was simultaneously administered as part of standard care. Results: From June 1, 2024 through April 30, 2025, eSyM questionnaires were assigned to 1161 cancer patients. 379 patients submitted ≥1 response (32.6%). 82 patients submitted >5 responses (7%). 176 patients reported severe symptoms (46.4%), potentially resulting in early identification and management of complications. Moderate symptoms were reported by 313 patients (82.6%), indicating ability of the eSyM tool to capture symptoms in a majority of users. A difference in ED visits and hospitalizations was noted between eSyM never users versus eSyM users. 28.1% and 39.2% of esym users and non-eSyM users respectively had an ED visit, an 11.1% difference. 20.5% and 28.1% of eSyM users and non-eSyM users respectively were hospitalized, a 7.6% difference. Numbers needed to treat were 9 and 13 respectively. Symptom severity captured by eSyM correlated with severity of patient distress simultaneously captured by the NCCN distress thermometer. Average distress scores in patients with moderate and severe symptoms were 2.94 and 3.26 respectively. A significant drop off in patient responses (32.6% ≥1 response to 7% > 5 responses) was noted, possibly indicating questionnaire fatigue and pointing to reinforcement opportunities. Conclusions: We demonstrate real world feasibility of eSyM usage in a large rural cancer care network. eSyM captured significant symptom burden in cancer patients and resulted in reduced acute care utilization, potentially due to timely symptom management. Low adoption and high drop off rates represent opportunities for improved care delivery.