Motivation

There is an increasing emphasis being placed on the self-reporting of issues faced by patients during the course of the disease. It is well known that patients perceive issues differently from physicians and in the context of diseases like cancer, understanding the patient's perception is of utmost importance. Unfortunately, in a busy clinical practice, it is often not possible to explore all the physical, psychological, social and economic issues that the patient may be facing due to time constraints. 
Electronic systems to record patient-reported outcomes provide a much-needed solution for this problem. They allow the patient to report their issues on pre-configured questionnaires before the clinical interaction with the health care worker. The same system can be configured to display the results to the health care worker during the interaction. The display can also be configured to show the temporal changes in the issues - which often adds very valuable insights on the issues as well as the impact of therapy on the said issues over a period of time. 
There are several commercial systems available for doing this but deploying these solutions in the clinic is expensive for practices based in India. We felt that an open-source system to collect self-reported patients' issues would help in integrating this practice more widely in the health care systems across the country. In the next few series of posts, we will detail how we went about designing the TMC PROM system. The objective behind the exercise is two-fold:
  1. To build up a knowledge base about the myriad ways various systems work and need to be installed - essentially serve as a manual for anyone who wishes to set up the system. 
  2. Have documentation of the work we do prospectively, such that enhancements and features can be described in details for end users. 

Choice of CMS

The system is based on Drupal - a free and open-source content management system. The choice of Drupal was based on the familiarity with the software and the immense flexibility that the CMS offers \cite{chakraborty}. Additionally, the system is robust and is currently used for multiple websites worldwide. Additionally, contributed modules like Webform allow the deployment of complex capabilities with little or no knowledge of coding. Finally, the system enables industry-standard access control and role-based permissions out of the box. 

Hosting Platform

As of the day of writing this post, the system is hosted on the Google Cloud Platform. A virtual machine (n1-standard-1) has been used. Google provisions 1 virtual CPU (vCPU) with 3.75 GB RAM for this machine.  As per the Google Machine Types page, these are optimized for web serving \cite{cloud}
To create an account with Google Cloud Compute you can see the following video. If you are doing this for the first time you can get a $300 worth credit over a period of 60 days. You will need to add a payment method to this account.