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I had only a basic understanding of Patient-Reported Outcome Measures (PROMs) until I worked with leading experts on the 2020 Digital Quality Summit (DQS). Here’s what I learned.
PROMs are already in use and include:
· The Person-Centered Contraceptive Counseling measure, which evaluates patients’ experience with contraceptive counseling at the provider and facility level at the University of California, San Francisco.
· The work being done by the Agency for Healthcare Research and Quality (AHRQ) at HHS to further the use of the HL7 FHIR PRO Implementation Guide, host the Step Up App Challenge for PRO apps and promote pilot tests in ambulatory care settings.
· The Patient-Reported Outcomes Measure Information System (PROMIS), established to measure physical, mental and social health with a standardized scoring model that allows comparison across measures.
PROMs have an HL7 FHIR Implementation Guide. This comprehensive guide discusses PROM development, deployment and operation, including workflow considerations. It’s a great way to get started with PROMs.
PROMs and health equity have important overlap. Four DQS breakout groups dug into key data elements that need to be captured about patients to achieve equity in health care—including gender identity (HL7 Gender Harmony Project), social determinants (HL7 Gravity Project), health equity and contraceptive access.
PROMs are different and there are issues. Because PROMs are, by definition, driven by patients, certain issues must be addressed to give a meaningful, statistically valid representation of a quality measure. There’s no standard sample size and because participation is voluntary—introducing potential reluctance on the part of participants—there may be (self) selection bias that must be considered/neutralized for measures to be truly meaningful.
PROMs will grow in importance. Patient-reported outcomes capture unique data points. They can do it directly, indicating quality of care received (CMS’s Comprehensive Joint Replacement program uses the PROMIS10 measure to drive incentive payments), or indirectly, providing information about patient demographics, their access to care, their willingness to receive care and more.
Share your thoughts in the community forum:
· What do you think is important to measure with direct input from patients?
· Do you see PROMs as a mechanism to capture important quality metrics on a national level?
Michael Klotz, Healthcare IT Entrepreneur, MK Advisory Services
Michael is a Healthcare IT entrepreneur, consultant and expert in the flow of data between patients, providers and payers (the healthcare data ecosystem), healthcare interoperability, digital quality and digital prescriptions. He applies his understanding of technology and standards, including HL7 FHIR, the regulatory environment, NCQA’s quality measures, the emerging digital quality standards (QDM-CQL, FHIR-CQL) and NCPDP standards to simplifying and automating secure data exchanges between patients, providers and payers.
Michael has built three successful companies, brought the first SaaS platforms for Medical Records Review to market and has been delivering strategic solutions for 120+ consulting clients for over 20 years.