Partners HealthCare is a national leader in pioneering the collection and use of a patient’s self-reported information about their health status. Called Patient-Reported Outcome Measures, or “PROMs,” the data are collected using clinically-validated questionnaires that ask about symptoms, functional status, and quality of life.
The practice has been around for decades, and it’s a powerful tool because information is reported directly by the patient. Until now, it hasn’t gained the desired traction because patients are asked to fill out the questionnaires using pen and paper in the waiting room. According to Neil Wagle, MD, a primary care physician at Brigham and Women’s Hospital, this analog approach makes it hard to gather and trend a patient’s answers over time, or even from one visit to the next.
“You have to transcribe all that information and even then it’s not usable in an EHR,” Wagle said. “And if it’s not usable in an EHR, then we can’t use it to guide or inform clinical care.”
At Partners, we’ve focused on leveraging technology to help us collect PROMs directly from patients in their homes, before an appointment, using the Partners Patient Gateway. Patients can also access the portal with wireless tablets in the doctor’s office. The doctor can then see the responses in the medical record when the patient comes into the exam room, making the patient’s time with the doctor more productive. With the questionnaire pre-populated, the doctor can focus on how the patient is feeling at that visit and compare that to how they rated their health during prior visits. The new system can monitor a patient’s progress for several years.
The quality of the conversation I can have with my patients is one of the real benefits of this system,” Wagle said. “I don’t have to spend my time asking repetitive questions, and I don’t lose the opportunity to get into the deeper nuances of patient care. This portal enables a much richer conversation, and creates better shared clinical decisions about the patient’s treatment options.”
The current Partners PROMs program started in 2014, and as of March, 2016, has collected nearly 125,000 questionnaires from patients in over 20 specialties and over 60 clinics at most of our hospitals. Collecting this patient data not only adds value to the doctor-patient encounter, but the accumulated data (without patient identification) can help clinical leaders detect best practices where one or more doctors or hospitals may have superior patient-reported outcomes worthy of system replication.
“With this information, I can look at the outcomes of 5,000 patients for a particular type of surgery, and speak with my patient about the expected outcomes and recovery,” Wagle said. “And I can do this with graphics, numbers—it’s approachable, and helps a patient wrap their mind around what to expect from certain treatment options.”
Recently, major insurers such as Medicare and Blue Cross Blue Shield of Massachusetts (BCBS) have also recognized the value of collecting this valuable patient-reported data. BCBS is collaborating with Partners to require the collection of PROMs in certain specialties as a way to simultaneously improve patient care and efficiency. Our goal is to have every specialty and institution within our network collecting PROMs data by the end of 2018.
Anchored by our academic medical centers—Brigham and Women’s Hospital and Massachusetts General Hospital—some of the world’s leading medical specialists have participated in the selection of the questions that patients answer. We hope to extend the program over the next several years until it eventually covers most clinical specialties.
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