Voxe: A Digital Health Platform to Capture Patient Voices and Enhance Clinical Care

Background: Voxe is a novel, child- and healthcare provider (HCP)-friendly, electronic patient-reported outcome measure (ePROM) platform developed via a user-centric approach to create a digital platform that engages and empowers patients and HCPs. Approach: Iterative rounds of co-design and usability testing guided the rigorous, user-centered development of Voxe. During testing, end users (i.e., patients and HCPs) completed task-based activities on Voxe, such as creating a profile or navigating to PROM results. End users commented on the platform’s ease of use and functionality, shared their perspectives of the Voxe design, and, ultimately, informed Voxe’s integration into the electronic medical record system, Epic. This study evaluated the implementation and preliminary effectiveness of Voxe in the Renal Transplant Clinic at The Hospital for Sick Children (SickKids). An implementation-effectiveness hybrid design was used. Eligible participants included patients (12-17 years old; minimum three months post-transplant) and HCPs who provided care to participating patients. HCPs received training on Voxe and integrating PROM data into clinical encounters. Patient participants received a text or email seven days before their clinic appointment to request completing PROMs through Voxe. HCPs were alerted in Epic following patient completion. PROM data was discussed during the patient’s clinic visit and integrated into their care plan as needed. Semi-structured interview data and quantitative metrics were collected and analyzed to assess outcomes. Results: Twenty patients aged 13.8 ±1.4 years and seven healthcare providers participated. Implementation Outcomes: The frequency of PROM completion correlated with patients’ clinic visits during the study, and the rate of ePROM completion was 95%, higher than most pediatric ePROM completion rates reported internationally (adoption). Patients described Voxe as ""easy to use,"" and many HCPs shared that they were satisfied with the ease of reviewing PROM data (feasibility). Voxe participation increased satisfaction with the clinic appointment for both HCPs and patients, with several patients sharing a preference for completing ePROMs in Voxe since they did not have to verbalize how they were feeling: “I prefer this more, instead of having to say how I’m feeling out loud” (acceptability). Patient participants preferred a text notification requesting PROMs completion, and HCPs highlighted how Voxe integration “fit” within their clinic (appropriateness). Effectiveness Outcomes: Voxe encouraged communication between patients and HCPs about quality of life (QoL) and mental health concerns. Several patients shared that completing ePROMs in Voxe allowed them to share their perspectives and participate in conversations about QoL: “…it helped me talk about things that I wouldn't necessarily speak about...I feel Voxe would help other patients”. Outcomes reflect participants’ perception of Voxe as adoptable, feasible, acceptable, and appropriate and demonstrate its effectiveness at fostering patient-provider communication. Implications: Findings support Voxe’s implementation and preliminary effectiveness as a novel digital health approach to capture patient voices and enhance the capacity of patient-provider partnerships to provide holistic, patient-centred care. Next steps include evaluating mental health measurement-based care (MBC) implementation using Voxe across SickKids and developing an Implementation Roadmap to enable broader dissemination of MBC across pediatric institutions.