Two people pointing at and using touchpad of a laptop. One person is wearing fitness watch computer and other has grey long sleeved top
Electronic patient-reported outcome systems could allow patients to complete questionnaires remotely and get near real-time responses from clinicians

Digital systems for patients to monitor and report symptoms remotely may offer a solution to reduce outpatient waiting lists, according to new research.

The review published in the Journal of the Royal Society of Medicine was led by researchers from the Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research at the University of Birmingham. The new findings published today looked at international examples of the use of electronic patient-reported outcome (ePRO) systems to triage clinical care.

ePROs allow patients to fill out questionnaires at home or location of their choice, with the results sent back to the clinician in near real-time to use in clinical decision-making. Studies of various groups of patients, including those with epilepsy, sleep apnoea, type 1 diabetes, cancer, rheumatoid arthritis and HIV, were included in the review.

In Denmark Ambuflex, a generic ePRO system, has been used in over 40,000 patients across a range of chronic conditions and has led to substantial reductions in outpatient appointments. In epilepsy clinics, the system led to reductions of up to 48% in in-person outpatient appointments.

Lead author Dr Lee Aiyegbusi, Associate Professor and Deputy Director at CPROR, said: “The use of PROs is well established in research settings to evaluate the effectiveness, cost-effectiveness and tolerability of interventions from a patient perspective. Clinicians are now interested in using patient-level symptom reporting for the clinical management of individual patients in routine practice.”

“ePROs for outpatient care could facilitate the tailoring of care to patient needs. Stable patients can be monitored remotely using ePROs, thereby avoiding unnecessary check-ups in outpatient clinics and associated costs, such as travel and time off work, without lowering the quality of treatment.

“This efficient use of scarce healthcare resources could free up outpatient clinics for patients with high symptom burden or concerning symptoms, so they can be seen more quickly.”

Stable patients can be monitored remotely using ePROs, thereby avoiding unnecessary check-ups

Lee Aiyegbusi

Significant reductions


The review provides evidence to support the implementation of ePRO systems for outpatient care, including significant reductions in outpatient appointments without compromising patient outcomes or satisfaction with care.

According to NHS England, in October 2022, more than 7 million people were waiting for consultant-led elective care. Backlogs and lengthy waiting times lead to worsened health outcomes and pressures on the NHS, disproportionally affecting people in rural areas, the elderly and the socio-economically deprived. Data from the West Midlands shows more than 1/3 of outpatient appointments do not lead to change in treatment or new investigation and may not be required.

Reductions in in-person outpatient appointments could lead to considerable cost savings and reductions in ‘did not attends’ (DNAs). The new approach represents a more responsive system, reducing demand for clinics and time to care when clinically indicated.

Two doctors holding an ipad consulting an image. One has a pen.
ePROs could enable healthcare professionals to prioritise seeing those with high symptom burden or concerning symptoms

The authors note that it is important to acknowledge that a proportion of patients, especially the elderly, may prefer face-to-face or telephone outpatient consultations regardless of their health status and may be concerned about or averse to the use of ePROs as a triaging tool.

The findings also demonstrate why it is crucial that the use of ePROs for outpatient care is carefully considered, planned and implemented to ensure that people from underserved populations are not further disadvantaged.

Professor Mel Calvert, Director of the Centre for Patient Reported Outcomes (PROs) Research at the University of Birmingham said:

“The use of ePROs in outpatient care could potentially allow a more responsive healthcare system, reduce demand for clinic appointments, reduce time to care with associated improved outcomes, and enhance cost-effectiveness of healthcare delivery – all of which are beneficial to patients, their families and society.”