Once the purpose for using PROs is defined, clinicians and their teams can identify the appropriate PRO assessment. The first consideration is whether a global or condition-specific PRO is the best fit. Global PROs measure patients' health status broadly, while condition- specific PROs measure aspects of health that are relevant to a certain medical condition. Both global and condition-specific measures change over time within a single patient, so if a clinician wants to compare a patient’s pain before and after surgery, for example, a global PRO may suffice. However, if a clinician wants to longitudinally track headache pain, for example, a migraine-specific PRO may be more suitable.

Clinicians may also want to consider whether the PRO they are using will allow comparison across multiple conditions and benchmarking. Newer PROs, like PROMIS, are designed to use a common scoring system. This simplifies comparison across multiple conditions. Legacy PROs are often condition-specific and do not easily compare with other measures.

Some clinicians may find that a set of PROs is most appropriate. It is possible to combine multiple shorter PROs to elicit the necessary data to meet your goal. For example, CMS recommends collecting a PROMIS (global) score and a knee or hip-specific score in total joint replacement patients.

HealthMeasures.net offers multiple tools that can help you select a PRO measure. The Summary Table is an especially useful tool to bring to a conversation between clinicians, office staff, and the IT team because it breaks down target populations, administration platforms, and features.

Last, health systems should monitor payer and regulatory requirements to ensure that they collect the recommended PROs.

The collection interval for PROs should match the clinical care process. This does not necessarily mean PRO collection needs to occur during busy office visits. Workflows can be designed to collect PROs prior to office visits and made available to the clinician at the visit. Our experience is that collecting PROs at regularly established intervals – not tied to office visits – achieves higher rates of completion and better data. Patients do not always return for office visits at clinically-defined intervals, particularly if they are feeling better – skewing PRO data. Collecting PROs separately from the office visit at pre-determined intervals avoids office disruptions and yields more complete longitudinal data on more patients.

If you are using PROs for quality or regulatory reporting, the payer will establish a collection interval. Planning for collection outside of office visits may become more important if your clinical workflow doesn’t line up with the collection interval required by payers.

Clinical researchers will want to work with the clinical team to determine the collection interval that meets research needs, while incorporating PRO implementation within the clinical workflow.

Implementing PRO capture through the EHR is an easy way to begin collecting PROs. However, there are limitations – and many alternative collection methods. The summary below outlines the advantages and disadvantages of using the EHR for PRO collection.

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The Pros and Cons of Using Your EHR for PROS

You may decide to manage PRO collection through the EHR patient portal. However, if PRO data are collected through alternate methods, the PRO data should be returned to the EHR for storage and use during the office visit. Prior to implementation, it is important to review best practices about protected health information security with IT security at your organization. It is key is to make sure patients know their PRO information is valued by the clinical team and is important to the visit.

Optimal PRO collection engages the clinical ‘microsystem’ including front line staff, administrators, information technology, and clinicians. Integrating PRO collection procedures into existing workflows need not place undue burden on clinic staff, clinicians, or patients. Web-tool or EHR patient portals can be used to solicit and collect PROs, as well as to conduct real-time scoring and return of scores to the EHR for storage. In addition, our experience demonstrates that simple additional steps — such as text or email reminders from the patient’s clinician — will increase PRO reporting rates.  Leveraging the microsystem to successfully collect PROs is reviewed in our paper below.
Pavetto C, Burla M, Lavallee DC, Levison TJ, DiGioia AM, Franklin PD. Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study. Jt Comm J Qual Patient Saf. 2023 Sep;49(9):474-484. doi: 10.1016/j.jcjq.2023.05.008. Epub 2023 Jun 16. PMID: 37455194.

The graphic below illustrates a workflow that can be used to collect pre-visit PROs and make them available to the clinician and patient to review during the visit. Using this method, most PROs can be collected before the office visit, leaving a minority to be collected during the visit. This reserves valuable staff resources for other clinical duties. This workflow and supporting materials can be found in our PRO Implementation Workbook.