No Paper, More Answers

Going digital allows closer interactions between patients, physicians

By Mayo Clinic Staff

New questionnaires on digital devices generate electronic patient reported outcome measures, known as ePROMs, which are available immediately to the patient's physician.

Anyone who visits the doctor's office and receives a stack of paper questionnaires upon check-in is justified in thinking, "There has to be a better way." This is the era of smart homes and self-driving cars, right?

The good news is medicine is catching up. More health care providers are switching to electronic pre-visit questionnaires and waiting room questionnaires delivered on mobile devices. But the real challenge is ensuring these questionnaires are just as intelligent as the latest "smart" gizmo. This means being succinct, addressing concerns that are most relevant to the patient's condition, adapting over time based on previous answers, and being linked to the electronic health record.

Researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery hope to achieve those goals by developing digital-based questionnaires — for use on iPads or smartphones as well as computers — for patients to complete while in the waiting room or even prior to coming to Mayo.

Working with the International Consortium for Health Outcomes Measurement, the research team is using standardized condition-based questions that take into account different environmental, behavioral and genetic risk factors that are most important for patients with specific medical conditions.

The iPad questionnaires have rolled out to several practice areas at Mayo Clinic's campus in Florida, including liver transplant. Currently, the questionnaire is provided at the patient's initial consultation and at the four-month and one-year post-transplant appointments. A separate iPad questionnaire assesses caregiver burden.

Together, the questionnaires generate electronic patient reported outcome measures (ePROMs) that are available immediately to the patient's physician.

"Our goal is to help drive conversations between patients and providers that will lead to more efficient and effective care," says Ryan J. Uitti, M.D., center site director in Florida. "In addition, we believe this will improve satisfaction with the health care experience and reduce costs."

The ePROMs information has implications beyond an individual appointment. Because it is added to the electronic health record, it builds a more complete picture of the patient that will help not only their current physician but other providers they may see down the road.

Additionally, the information from many patients feeds into a collective database that is a gold mine for researchers seeking to improve outcomes for patients, including overall quality of life for liver transplant patients. For example, depending on the patient's condition and health, a liver transplant can involve a whole or partial liver from a living or deceased donor. Over time and with enough patient records, ePROMs information could help predict an individual patient's quality of life for each transplant option based on their condition.

"While many opportunities exist to use ePROMs, we are just getting started," says Dr. Uitti. "We want to incorporate them in more ways and deliver them in more venues, obtaining information in the process that helps care for the individual patient today and improves patient care in the future."

Researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery use technology and other approaches to apply engineering principles to re-imagine the health care experience. Support our efforts today.