When it comes to the field of health informatics, I personally define it as taking messy raw unstructured data and transforming it into actionable insights but to what end? I would argue the point of this field is to ultimately improve patient outcomes.
Peter Drucker is often quoted as saying, “You can’t manage what you don’t measure”
If we want to make sure we are managing and creating quality improvement initiatives around the right measures, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are key to include in our key performance indicators.
PROMs and PREMs are usually questionnaires that are administered to the patient, without clinical intervention, for them to report on their experience concerning their symptoms, quality of life, and/or the care being provided to them. We often talk about the importance of patient-centered and person-centered care and directly hearing from the patient in the form of these questionnaires is key to ensuring the patient’s voice is heard.
PROMs are usually more focused on the patient’s symptoms and their health status whereas, PREMs are usually focused on the patient’s perception of the level of care they have received or on their patient journey. I have written previously about one PREM metric, the Patient Satisfaction Score, as one of the Hospital KPI metrics reported in Clinical Dashboards.
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Patient Satisfaction (PREM): Can be a score provided by the patient, rating the care provided, with a score of 1 being very unsatisfied to 5 being very satisfied.
This PREM can be more detailed than just looking at the overall care provided, it can also look into whether the patient felt heard at their appointment, whether it was easy to find their appointment at the healthcare organization, and other details related to their visit.
Oftentimes these tools can be administered through a paper form but as we move to digitizing the health care experience some organizations are implementing these tools directly within the Electronic Health Record (EHR). This can be a challenge to implement within the clinic workflow, for staff to have enough time to review the PROM or PREM with patients, in addition to all the other tasks that need to be done during a clinic visit.
However, several articles, here and here have linked high symptom burden scores with increased ED visits. Therefore, there is a benefit to implementing PRO and PRE measures into practice. In addition, PROMs and PREMs can have benefits, one article mentions that tracking a patient’s symptoms over time might reveal that a patient could have a negative adverse reaction to a new chemotherapeutic drug.
Segwaying into another informatics discipline, Bioinformatics…
I previously wrote an article about some of the challenges of integrating genomic data into the EHR and how one EHR, MEDITECH, launched Expanse Genomics which “offers enhanced connectivity with reference laboratories to allow for communication of genetic data in ways that have not been previously envisioned in the marketplace“. MEDITECH has recently worked with Frederick Health to allow for genetic test ordering, as well as storage of discrete genetic test results, directly within the Expanse EHR. Here in Ontario, Ontario Shores Centre for Mental Health Sciences recently implemented MEDITECH’s Expanse Genomics solution into their EHR system. Jennifer Ford, MEDITECH’s manager of clinical strategy and genomics stated about one of the most promising use cases in the field of oncology: “With the specific genetics of a patient’s cancer, their hereditary risk and all of the demographic and other information in the EHR, Expanse Genomics is able to search clinical trial databases and find a match,” Ford said. “And if a new therapy hits the market that might be better for the patient, we can immediately match them to it by having all the information in the EHR.”
This can allow for synergies between the health informatics and bioinformatics fields.
Storing the patient’s symptom burden (PROMs) and experience of their health visit (PREMs), alongside their genetic history all within one centralized EHR system, instead of across disparate systems, could lead to a reduction in administrative burden and improved patient outcomes. Including the patient’s experience, as well as, their genetic history could lead to more holistic care being provided to the patient, with their voice included.
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