How Vanderbilt Logged 1M Patient-Reported Outcome Measures (PROMs)

As the healthcare world gradually shifts its focus toward patient-centered care, Vanderbilt's clinician-patient communications tool has achieved a significant milestone, recording its millionth patient-reported outcome (PRO), a tool for gauging patient experience.  

Over the last two decades, PROMs, also known as patient-reported outcome measures, have had a slow but steady stake-off. Unlike traditional clinical quality metrics like hospital readmission rates, PROMs capture patient perspectives of health outcomes, quality of life, and functional status. 

Today, these personal health assessments can give a look into various health outcomes, from the effectiveness of medications to the impact of physical therapy, having grown from a niche concept to a cornerstone of patient-centered care.  

Healthcare organizations measure patient experience and patient satisfaction to determine how patients feel about their care. 

“At its core, VPROMS is a clinician-patient communications tool,” Justin Bachmann, MD, MPH, a cardiologist and medical director of Patient-Reported Outcomes Measurement at Vanderbilt.  “It’s an effort by the Medical Center to listen to patients more effectively. PROMs are really one of the only objective forms of symptomatic data because everything else is interpreted by the clinician and put into the chart.” 

“This is a way to cut through that and find out how the patient is actually feeling.” 

The VPROM program, which is the Vanderbilt-specific PROM system, began as a pilot in 2019 at three clinical sites and has since reached over 30 locations. The program, incorporated into VUMC's Epic-based EHR, eStar, is available at any participating site.  

Through this recently implemented program, patients receive a PROM survey via VUMC's online portal, My Health at Vanderbilt, 72 hours before a clinic visit or can fill it out on a clinic tablet. The survey data is added to a patient's EHR and then is accessible to patients, healthcare providers, and researchers. 

According to Bachmann, when patients complete multiple surveys over time, providers can observe longitudinal patient trends. One key example of PROM's impact is seen in bariatric surgery patients at VUMC. The patients' scores on PROMs—accounting for mental, social, and physical well-being—jump from an average of 40 before surgery to over 80 a year after, effectively doubling their quality of life. 

“One of the real advantages of collecting PROM data is that it gives you a better sense of symptoms over time,” Bachmann said. “How were they feeling two weeks ago, four weeks ago, eight weeks ago? You can clearly see trends.” 

Despite initial worries that these surveys might disrupt the clinical workflow, it turned out not to be an issue. Bachmann noted, “A lot of clinical sites initially had concerns that these questionnaires might slow down the clinical workflow, but that hasn’t proven to be the case. The average amount of time to fill out these questionnaires is about seven minutes.” 

Additionally, the team also developed methods to extract VPROMS data to aid clinical investigations. 

“The ability to leverage PROM data is something that distinguishes us from other academic health systems and large hospital systems, and it’s due to VUMC’s historical strength in biomedical informatics, as well as our excellent relationship with Epic,” Bachmann stated. 

The VPROM program has set a significant completion rate target for the fiscal year 2023, which it has already surpassed, achieving a 61 percent completion rate against a 60 percent goal. 

While the VPROM program indicated promising success, the collection of PROMs can present significant challenges. Much like other patient engagement efforts, the success of gathering PROMs hinges entirely on patient response rates. 

Data from 2022 also shows that only 1 percent of doctors use PROMs in their healthcare practice. Understanding the barriers to using PROMs will be key to improving the patient experience of care and patient outcomes. 

Another considerable challenge lies in linguistic barriers. Patients with limited English proficiency (LEP) are often excluded from PROMS due to language barriers, an issue that needs addressing for wider and more equita