Flip No. 16

Collect patient-reported data

Integrate patient-reported data into the flow of clinical care.

By Flip the Clinic

So much of what happens during a patient’s one-on-one with a clinician involves data-gathering. Where does it hurt? How long has it been bothering you? What are your other symptoms?

Communicating these concerns is important, but the delivery takes up precious minutes that would be better spent on activities like shared decision making.

In a report published in 2012, the Dartmouth Institute for Health Policy and Clinical Practice looked at three health centers that had flipped the way they handled patient data collection. Instead of gathering patient information during the visit, these centers asked their patients to fill out a series of health questions before they saw their doctor, either via a secure patient portal at home or at an iPad station in the waiting room. What the researchers found was that by front loading the data collection, the health centers studied increased the value of care delivered to patients. Patients and providers were able to spend more of their time discussing a patient’s treatment plan. And when patient data was integrated with a provider’s notes and test results, the contribution helped create a more complete portrait of a patient’s health. Over time, the health centers were able to use the data gathered to learn more about their larger patient populations as well as their own long-term performance.

Dartmouth’s study identified a set of best practices for a system designed to capture patient-reported data.

1. Patient-reported data should be seamlessly integrated into the flow of care. Data collection should make it easier for clinicians to do their jobs and for patients to manage their own health.
2. Design the portal for patient-reported data with input from all the system’s stakeholders.
3. Discuss the best uses for patient-reported measures with both patients and clinicians.
4. Making the best use of patient-reported data means combining it with other streams of information. Design a system that brings together patient-reported data with clinician reports, medical records, claims, etc.
5. Keep the system current by staying up to date on new technologies and user feedback.

How to integrate patient-reported data into the flow of clinical care:

1. The patient schedules a visit.
2. Either through a secure patient portal at home or an iPad station in the clinic’s waiting room, the patient answers a series of questions that provides the care provider with health data.
3. A summary report of the patient’s health data is automatically created.
4. The patient sees a clinician. Together they review the patient-reported data and make a health plan.
5. The clinician reports on the patient visit. The notes are added to the patient-reported data.
6. Data from patients, clinicians, and diagnostic tests is stored, managed, and analyzed.
7. Reports on individual patients, clinical populations, and the clinic’s performance are generated.

Case Study

In a study that looked at two patient-reported data systems, one at the Dartmouth-Hitchcock Spine Center and another at the Karolinska University hospital in Stockholm, Sweden, 80 percent of patients rated the system “excellent to good,” and one third of patients believed that the systems had led to positive changes in their visit. After using the systems, providers noted how crucial patient-reported data had become for follow-up visits and patient feedback. The information made it easier to broach mental health topics, start a conversation with patients, and get patients involved in managing their own health.