Page 9 - Rochester Medicine | 2019 Volume 1 | University of Rochester Medical Center

The Promise of Patient Data Analysis

Northwestern University. “It is clear that their use; to date, more than 40 clinical
the University of Rochester system is departments and divisions have followed
indeed at the forefront of innovation in Orthopaedics’ lead in offering it to their
health care. They have figured out how patients.
to truly integrate the patient perspective Patients’ input on what worked for
into their evaluation of clinical outcomes them—and what didn’t—is creating a kind
across the system.” of health care “trip advisor” for providers
What’s different about the way as they seek the best care pathways for
University of Rochester uses PROMIS? future patients.
In 2014, a team led by Orthopaedics “This information has real clinical
professors David J. Mitten (BS ’88, MD value—as a physician, it can change how
’92, Res ’97); Judith F. Baumhauer, we practice,” says Baumhauer.
MD (MPH ’09, Flw ’09); and PROMIS When Baumhauer looked at aggregate
IT Project Director Chris Dasilva data on Brostrom lateral ligament
replaced the PROMIS hardware with reconstruction for chronic ankle sprains,
In the national drive to improve health a custom-built solution linked to the which she and her fellow foot and ankle
care quality and value, the University of University of Rochester Medical Center’s surgeons have performed for years, she
Rochester is seeking input from one group own technology enterprise. The new discovered that the most expensive
of experts who haven’t weighed in yet: the technology and collection process— variation of the procedure, using a
patients themselves. dubbed UR VOICE—instantly collects fiber tape augmentation, was also the
Surveys of patient experiences are not patient-reported PROMIS data and makes least effective. This is just one example
new to health care. Providers have long it available for viewing in eRecord, of hundreds that have been assessed
used them to assess the quality of care URMC’s electronic health record system. with the patient front and center in the
they deliver, but they had limitations. judgment of the treatment.
They were rendered sporadically, and PROMIS also encourages shared
only after the care was complete. “It is clear that the decision making between provider and
Facing those challenges, Northwestern University of Rochester patient. “This program is the ultimate
University made a leap forward in 2009 by in paying it forward,” Baumhauer adds.
developing the PROMIS patient reported system is indeed at the “It puts the patient front and center in
outcome tool, with funding from the forefront of innovation health care and ensures that their voice
National Institutes of Health. in health care.” is heard. For the first time, the patient’s
PROMIS (Patient-Reported Outcomes own perspectives on their care are part
Measurement Information System) is –David Cella, Northwestern University, of their permanent health record, right
a computer-driven survey that uses who led the creation of PROMIS alongside the doctor’s.”
adaptive technology and item-response As of September, the University of
theory for highly detailed, accurate The UR VOICE team then built a process Rochester has collected 2 million patient
results. The technology was powerful and to collect assessments on iPads that assessments in just three years. The
had great potential, but presented a new patients get at check-in. While they nine-member UR VOICE team is in high
challenge for health care systems: How to sit in the waiting room, patients tap demand at international conferences to
efficiently gather information from large their answers to questions about pain, present its findings; New England Journal
numbers of patients in a clinical setting, function, and mood. Physicians can view of Medicine Catalyst invited Baumhauer
so the wealth of data would be easily patient responses instantly and go over to deliver a TED-style talk in Los Angeles
accessible and usable by clinicians. the results with the patient during their in January 2019. She and clinical faculty
The Department of Orthopaedics visit. Patients get a vivid picture of their have published perspectives about the
devised a solution that has quickly built progress: the URMC-designed interface value of PROMIS—and UR’s leadership
its reputation as a leader in implementing displays their cumulative pain, mood, in implementing it and using the data—in
patient-reported outcomes, according to and physical function scores as line NEJM and other journals.
the Northwestern researcher who led the charts. Physicians use the data to spark “We see this becoming the standard
creation of PROMIS. conversations with patients and engage of care, something that happens at every
“There are a handful of organizations them in shared decision-making on their visit, the same way you would take a
that made the kind of ‘all-in’ commitment care. patient’s blood pressure,” Mitten says. “We
it takes to succeed in re-engineering a As medical director of PROMIS want to be the first medical system in the
system as large and complex as health and patient derived data for URMC, United States that collects data on every
care,” says David Cella, PhD, chair of Baumhauer works with clinical areas patient who comes through the door.”
the Department of Medical Sciences at to help them adopt the technology for

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