PROMs Integration: Understanding the Challenges Specific to These Data
This article was informed by The Clinician’s conversation with Greg Robinson of ICHOM.
A Chief Technology Officer by title, Greg’s role straddles the line between CTO and Chief Strategy Officer as he, together with his colleagues and the ICHOM board, navigate ICHOM’s mission to move the needle on value-based healthcare on a global scale.
The Clinician is proud to be the official technology and implementation partner for ICHOM in Asia Pacific and the Middle East.
Electronic health records (EHRs) have always done a great job gathering diagnostic and treatment data relevant to payers for two main reasons: one because they grew out of billing systems and two because they are still largely the basis for billing and reimbursement. Simply put, collection is far more assured where data corresponds with a distinguished billable event.
But patient-reported outcomes themselves are not billable events, and their measurement is not required for reimbursement. The resultant lack of standardisation in reporting PROMs creates a barrier to data collection and usage.
Current Lack of Methodology Standards for PROMs
It’s difficult to actually derive standardised patient-reported outcome measures (PROMs) using the tools that are out there. Although there are a variety of apps, there's no standard mobile app, no standard tablet app. For example, there's no EHR equivalent where there’s EPIC and then here's the EPIC PROM.
And PROMs themselves are developed over time—gaining legitimacy as a valid tool through research and within the literature. But PROMs are somewhat standalone in terms of being integrated into patient care at the point of care, and in being data collected by health systems, providers, facilities, hospitals, etc.
The lack of standardisation creates a barrier. Granted, some EHRs have made strides in attempting to provide methods and means for these data to be gathered. But because PROMs aren’t required for reimbursement, the level of consistency in terms of actual collections of these measures can (and often does) vary considerably.
And at some point in the future, we would love to see these espoused by payers in such a way that it is basically standard fare and required as part of value-based payment to understand patients and their reported outcomes in relation to the treatment and care that's been delivered. But that is not the case today.
The case for requiring data capture
The lack of absolute requirement for the underlying organisations that use these vendors to capture the PROMs data is hampering the ability for information to be easily shared with other systems.
For any health system, whether it is, at the end of the day QI (quality improvement) programs or the like will drive the following: Okay, we want to start capturing these patient-reported outcomes, how do we do this?
Well, you can pick from one of the vendors out there, develop something on your own, maybe a kiosk as patients come in, or simply a Google form—there’s no shortage of technological ways.
And this is why, from the perspective of digital health systems and vendors, it’s not that they are necessarily falling short, per se. The problem arises because there are differing use cases and there's no standardised compelling use case, and because of the lack of unified compelling need by the organisations that employ them.
Slow adoption as a key barrier
The key barrier is the slow adoption of technology, although adoption is starting to increase due to efforts on the parts of regulators and payers. And healthcare overall has been a relatively slow adopter of technology. Take the finance sector—they figured out interoperability a long time ago; my AMEX card will work anywhere on the planet. But I can go anywhere on the planet and no one will know my underlying health conditions or what I need, because of the slow adoption of technology.
Consider the example of healthcare providers in the United States: in one state there will be a certificate of need application process that defines how many hospitals can be built and where they can be located. But in another state there might be no certificate of need, and the organisation can build what it wants where it wants. The challenges posed by the lack of consistency in regulation, whether at the local, regional, national, or international level, results in the differential use of technology.
That hesitance to adopt the technology and the lack of standardisation both have the same relative genesis. Looking again at the retail sector or the finance sector, some of the underlying drivers and need for interoperability has propelled the use of standardised technology.
ZEDOC is a complete platform solution for the end to end management of PROMs, helping you capture standardised outcomes directly from patients in the clinic or remotely.
Overcoming the technological, operational and integration barriers preventing PROM use in routine care, the ZEDOC platform can help you deliver seamless experiences for both patients and care teams.