Interest in Patient-Reported Outcome Measures (PROMs) Growing

1. Develop standards to capture structured data from patients and families. The Office of the National Coordinator for HIT (ONC) and the HIT Standards Federal Advisory Committee have done a laudable job in creating standards for data inputted by providers. The certification process has reinforced the use of specified standards, such as rxNorm and SNOMED, for provider-reported data in EHRs as structured data. Similarly, patient-reported data will need a standardized data model to capture patient symptoms and health, such as difficulty breathing, functional status, or mental health. The need for standards will become increasingly important as we begin to move beyond capturing simple information, such as five-point Likert scales in PHQ-9 for depression, to more complicated information.
2. Create patient-friendly, digitally enabled instruments. Given the varying levels of health literacy and technology comfort across populations, we need to develop reliable and valid tools that are simple, quick, and optimized for health IT. Priority should be given to high-impact conditions, such as heart failure, diabetes, ischemic heart disease, depression, and cerebrovascular disease.
3. Develop portals for patient reporting optimized for mobile devices. We also need to develop secure portals enabling patients to report outcome data seamlessly either from home or at their provider’s office. Ideally, these portals would be optimized for smartphones or tablets. Already one-third of Americans are smartphone owners, and this number will likely continue to increase. Similarly, tablet ownership has been rapidly rising, notably from 3 percent in May 2010 to 19 percent in January 2012. As more Americans continue to access the Internet via mobile devices, we need to develop the tools to leverage these relatively easy-to-use technologies. Data submitted via these portals could be stored in a patient’s electronic health record and then used for quality improvement or reporting, or both.
4. Research whether adoption of PROMs translate into better health and better care. As numerous studies have pointed out, the evidence supporting the ability of health IT to improve quality and health IT is mixed. Health IT may indeed have unintended consequences, such as resulting in more frequent diagnostic testing. We need to better understand whether the adoption of PROMs will lead to better care and better health. We also need to develop electronic clinical decision support tools that will be needed to drive quality improvement on these measures and the electronic reporting structure to submit them to payers.

Interest in PROMs continues to grow rapidly. The proposed regulation for Meaningful Use Stage 2 underscores CMS’s interest in PROMs through its requirement for patient engagement functionality and inclusion of three proposed electronic quality measures incorporating patient-reported functional status. Some of the ONC Beacon communities are piloting PROMs and implementing them in clinical practice. Care Partners Plus®, a for-profit company, created a patient-feedback system for use in provider offices immediately after patient appointments, which could be used for PROMs as well.

Our ability to capture information from patients and integrate it into electronic health records and clinical care is rapidly evolving. As we move toward a patient-centered, high value health system, PROMs can play an integral role if we develop the needed standards, tools, portals and evidence base.

Thomas Tsang, MD, MPH, FACP, is currently a healthcare consultant and clinical advisor to HIT companies focusing on triple aim goals like Avado, SA Ignite and Acupera. His prior engagements include Senior Advisor to the Governor of Hawaii and Medical Director, Meaningful Use and Quality at the Office of the National Coordinator for Health Information Technology and served on the staff of the House Committee on Ways and Means. He participated in the development of key provisions in the HITECH Act of 2009, the House Healthcare Reform legislation and the National Quality Strategy. View LinkedIn Profile.

Faraz Ahmad, MD, is currently a staff physician at the Philadelphia VA Medical Center and a member of both the Center for Healthcare Improvement and Patient Safety and the Center for Therapeutic Effectiveness Research at the University of Pennsylvania Perelman School of Medicine. He graduated from the University of Chicago School of Medicine with honors in 2009, and he completed his Internal Medicine Residency at the Hospital of the University of Pennsylvania in June 2012. He formerly was a summer analyst at the Office of the National Coordinator for Health Information Technology, a researcher at The Advisory Board Company in Washington, DC, and an Albert Schweitzer Fellow. His interests include health IT, quality and outcomes research, and cardiovascular disease.  

This article post was first published at the Health Affairs Blog.