THU0247 Spa-net: a disease-specific integrated ehealth system and quality registry for spondyloarthritis in daily practice in the netherlands
Authors: C. Webers, E. Beckers, Y. van Eijk, H. Vonkeman, M. van de Laar, P. van Riel, M. Efdé, A. Boonen, A. van Tubergen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Regular and personalised monitoring of disease activity, physical activity, medication use and side effects is essential to improve and maintain patients' health-related quality of life in spondyloartritis (SpA). Transparency on outcomes, safety, practice variation and efficiency of care are increasingly demanded. Furthermore, patient empowerment and shared decision making are advocated. An integrated eHealth system including an electronic patient medical record (EMR) and real-time quality management system could provide a solution to meet these demands. <h3>Objectives</h3> To develop and test the feasibility of a disease-specific integrated eHealth system and quality registry for SpA in the Netherlands ('SpA-Net'), in order to 1) improve the quality of care for the individual patient, 2) provide transparency on treatment results, practice variation and costs and 3) to produce data for scientific research. <h3>Methods</h3> The eHealth system was developed in four phases. First, the content and design were discussed with experts in the field of SpA and patients (pts). Second, the database, EMR and quality management system were developed. Third, multiple rounds of internal and external testing were performed in collaboration with IT specialists, care providers and pts. Fourth, the eHealth system was implemented in practice and feasibility was tested among pts and care providers through semi-structured focus interviews. <h3>Results</h3> SpA-Net was designed and developed in 2015 and implemented into practice in May 2016. All pts entered into SpA-Net have a diagnosis of SpA according to their treating rheumatologist. There are no inclusion or exclusion criteria towards the subtype of SpA or treatment. Information prospectively collected at routine outpatient consultations on diagnosis, demographics, specific SpA manifestations, patient reported outcome measures, clinical outcomes, comorbidities, medication use and safety, supplemented with data from the hospital information system, is directly stored in a database. The comprehensive individual patient data are readily available to the physician and an excerpt of this can be accessed by the patient. Prior to each visit, pts complete online questionnaires. The information is presented in graphs wherever possible (figure 1). In December 2017, 1078 pts participated in SpA-Net (mean [SD] age 53.7 [14.3] years, 46.6% females), and inclusion is ongoing. Focus group interviews were held with 16 pts, 9 rheumatologists, and 5 nurses. Pts considered the layout of SpA-Net as clear, accessible and intuitive. They felt the use of questionnaires resulted in better quality of care and communication, and appreciated having access to their EMR with lay-term explanations. Points of improvement were the login process and providing more details about the care provider's notes. Care providers appreciated the additional information for (preparing) consultations. Barriers against use of SpA-Net were the initial time required to adopt the EMR and the quantity of data entry. <h3>Conclusions</h3> SpA-Net enables regular monitoring of pts with SpA and can serve as a first step to optimise knowledge and communication between pts and care providers. Both pts and care providers thought SpA-Net improves quality of care in daily practice. <h3>Disclosure of Interest</h3> C. Webers: None declared, E. Beckers: None declared, Y. van Eijk: None declared, H. Vonkeman: None declared, M. van de Laar: None declared, P. van Riel: None declared, M. Efdé: None declared, A. Boonen: None declared, A. van Tubergen Grant/research support from: AbbVie, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer, UCB