Harnessing Big Data to Track Patient Reported Outcomes, (Part I)
National standards are increasingly using data-based evidence to review the utility and value of medical services provided. For instance, the Getting It Right the First Time (GIRFT) campaign through the UK National Health Service (NHS) uses a peer-to-peer approach to tracking and analyzing patient data from questionnaires, electronic medical records, and other sources to identify best practices and areas for improvement.1 In the USA, the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System routinely collects and analyzes quality data to direct incentive payments to providers based on performance.2 Strategies like these are often described as a ‘big data approach’, which simply means the analysis of large, robust data sources to identify opportunities for modeling or improvement.
Quite often surgeons and ophthalmologists are challenged with processes to routinely follow up with their patients after a procedure. As a result, inconsistent tracking of outcomes and patient satisfaction with procedures can occur over time. This could be especially important for patients receiving cataract surgery with intraocular lens (IOL) implantation, as the particulars of improved vision, or the perception of less-than-adequate improvement, can substantially affect overall patient satisfaction and quality of life over time. In an effort to reflect the goals of GIRFT, PQRS, and other data-driven care improvement initiatives, innovative tools for tracking patient data are being considered in ophthalmology and other specialties.
Patient Reported Outcomes Tracking
To better track patient reported outcomes in the setting of IOL implantation procedures, Rayner offers the RayPRO platform that captures and reports real-time patient feedback and other data over a period of three years post-procedure. The tool not only tracks surgical performance over time but can also be used for surgeons during the recertification process, and to demonstrate the value of surgical services to potential patients. While I endeavor to follow up with patients routinely to track outcomes such as refractive outcomes and visual acuity, my ability to track patient satisfaction over time has been lacking, and a platform such as this one fills this gap very well. Moreover, I think for ophthalmologists that do not currently track patient outcomes on a regular basis, this technology would definitely encourage it. The platform is free and provides the practice staff a straightforward interface for patient registration and online questionnaire response. Within my practice, I found that assigning a dedicated individual within the surgery center to manage the patient registration and incoming data further streamlined the process. At the time of discharge, I also provide an information sheet to the patient or caregiver that describes the goals of the tool and helps patients or caregivers connect.
The platform sends a series of five brief questionnaires via email for patients to complete over a period of three years, with each questionnaire containing no more than six questions. Resulting data can be viewed by the practice staff and summarizes patient satisfaction with procedure results over time and the surgical center experience. The questionnaires also capture aspects of visual function such as the need for glasses, post-surgical visual disturbances, and subsequent follow-up procedures such as laser surgery to further improve vision. Some of this information may be acquired separately by optometrists or other ancillary healthcare personnel. I believe the platform allows for more frequent communication between ophthalmologists and these other providers, and therefore represents an opportunity to discuss and analyze these longer-term patient outcomes after surgery in the hopes of consistently delivering better care over time.
Aside from patient satisfaction, I especially appreciate other measures tracked. For instance, the platform allows patients to rate their degree of independence from glasses, which reflects how patients live on a daily basis. In fact, when some degree of spectacle independence is the desired outcome, I believe this metric to be even more important than other post-operative outcomes typically measured by surgeons, such as post-operative refractive error, predicted spherical equivalent or even best spectacle corrected visual acuity.
Patient privacy is an important consideration, and the platform only captures data that are directly relevant to patients and surgeons. The tool is designed to be compliant with the UK’s General Data Protection Regulations (UK GDPR),3 as well European GDPR and the USA HIPAA data protection regulations.
I am excited about big data solutions to monitor and improve outcomes and will continue to encourage my patients who receive Rayner IOLs to enroll in this innovative program to report their feedback over time. In my second article on this topic, I will provide some additional perspective on my initial patient outcomes tracked through the RayPRO platform.
- Getting It Right First Time (GIRFT). https://www.gettingitrightfirsttime.co.uk/. Accessed September 8, 2021.
- Physician Quality Reporting System (PQRS) Overview. Centers for Medicare and Medicaid Services (CMS). https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/downloads/pqrs_overviewfactsheet_2013_08_06.pdf. Accessed September 8, 2021.
- UK General Data Protection Regulation (UK GDPR). International Commissioner’s Office.
https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/. Accessed September 8, 2021.