Patient-Reported Outcomes – Harnessing Patients’ Voices to Improve Clinical Care
The New England Journal of Medicine recently published Dr. Ethan Basch’s piece on the value of incorporating patient-reported outcomes in electronic health records to improve clinical care.
The growing prevalence of technology in healthcare has narrowed the gap between patients and providers. With respect to PROs, patients can now log their health data through questionnaires and surveys for providers to review between visits. This flow of information improves patient-provider communication and allows providers to make more informed clinical decisions. Dartmouth-Hitchcock Medical Center, Cincinnati Children’s Hospital, the Cleveland Clinic, and Memorial Sloan Kettering Cancer Center – among others – currently incorporate systematic PRO collection into clinical care for patients diagnosed with certain conditions, with use cases quickly expanding.
However, there are three key barriers standing in the way of widespread implementation:
From a technical standpoint, the most dominant EHR vendors only have the ability to collect basic PRO data through patients accessing online portals and completing relevant surveys. Smart phone-enabled solutions are best positioned to optimize patient engagement and result in consistent data collection, but a dominant solution has yet to capture the market.
Reimbursement also poses a challenge in that CMS and ONC recognize the power of PROs, but have not provided strong financial incentives for health care organizations adopting PRO-collecting data systems. CMS does offer modest per-member-per-month payments for remote monitoring of chronic conditions, but health care organizations cite expenses and logistic changes as strong deterrents.
Clinical Workflow Integration
Despite the rapid growth of technology-based solutions in healthcare, the experience of a medical appointment has yet to be disrupted. Providers have always gathered patient-reported information, but this has typically been done verbally. PRO collection allows patients to remotely submit information directly to providers. Providers now face the challenge of integrating this data into their typical clinical process, shifting workflows over time.
The hospitals mentioned above created their own electronic PRO platforms with hopes of improving quality of care and patient satisfaction. Going forward, both increased reimbursement and more streamlined implementation guidelines will be instrumental as PRO initiatives gain traction.