Wider stakeholders’ perspectives on what is needed to implement electronic patient-reported outcome systems across UK kidney healthcare organisations: a qualitative study

Background: Implementing large scale electronic patient-reported outcome (ePRO) systems into clinical pathways requires these systems to cross the organisational boundaries of healthcare providers. Doing this successfully requires involving all stakeholders. However, previous research mainly focused on individual patients and healthcare professionals, leaving wider stakeholders’ perspectives on how to implement cross-organisational ePRO systems for direct care purposes largely unknown. Methodology: Using hospital-based kidney services in England (United Kingdom) as the exemplar context, we conducted 18 semi-structured interviews with key informants from national stakeholder organisations involved in delivering, commissioning, evaluating, or improving healthcare services. Interviews explored participants’ views on ePRO systems, including their perceived value, implementation challenges, and factors influencing uptake in routine clinical practice. We applied the i-PARISH implementation science framework to thematically analyse the data. Results: Participants reported limited awareness of ePROs and their potential benefits within their professional communities. Acknowledging the constrained resources and competing priorities within the healthcare system, stakeholders saw value in harnessing existing regional service improvement networks to support ePRO system implementation across care pathways. They emphasised the need for coordinated efforts among national stakeholder organisations to drive and support local implementation. They also identified high quality evidence of the clinical utility and positive impact of ePROs as a requirement for successful large-scale implementation, highlighting different types of impact as primarily relevant. Anecdotal evidence of ePRO benefits and real-world evidence of feasibility from local pilots were mentioned as complementary sources of knowledge to strengthen the case for cross-organisational ePRO system implementation. Conclusions: Successful implementing cross-organisational ePRO systems in England’s kidney services requires stakeholders to be better informed about ePROs’ potential value, supported by robust and real-world evidence. In a healthcare system facing resource pressures and competing demands, leveraging existing regional service improvement initiatives and coordinated leadership from a national cross-stakeholder group were considered key drivers of implementation success. Future research should strengthen the evidence base for ePRO systems’ effectiveness and implementation, while also exploring available health IT infrastructure. This will shape implementation strategies that enable healthcare systems to fully realise the potential of ePROs to improve services and outcomes.