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February 9, 2017

Paper, Paper, Paper, and all those little black dots!

By Elizabeth Zimmermann

examples of blank medical formsWhy are you asking me this again? What does this have to do with my visit today? What does my doctor do with all these forms?

These questions, and others, led researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery to consider the use of ‘smart,’ digital questionnaires delivered on an IPad in the waiting room, or via text or email to a patient’s preferred device or home computer before their appointment.

Ryan J. Uitti, M.D.

“Questionnaires are designed to collect what we call ‘patient reported outcome measures,’” says Ryan Uitti, M.D., center site director in Florida. “The information collected in patient questionnaires helps health care providers understand what patients are experiencing, and what health or health-affecting issues need to be addressed.”

“What is important to the patient can then be the focus of the discussion between the patient and physician.”

However, sometimes the forms are very long. Sometimes they ask about things that are not relevant to the key concerns of the patient that day. Often they require answers that haven’t changed – or won’t change – since the last time the question was asked. And none of the paper forms are immediately, or effectively, linked to the electronic medical record.

Dr. Uitti’s research team hopes to change this.

“Our goal is to help drive conversations between patients and providers that will lead to more efficient and effective care,” he says. “In addition, we believe this will improve satisfaction with the health care experience and reduce costs.”

He also notes that by providing responses to electronic questionnaires like these, patients are contributing to broader data collections that will improve care for future patients.

Working with the International Consortium for Health Outcomes Measurement (ICHOM), they are creating standardized condition-based questions. Different environmental, behavioral and genetic risk factors are most important for patients with different conditions. For example, for a patient seen by their doctor following a liver transplant, questions will be different from those seen following heart surgery.

Several practice areas across Mayo Clinic have adopted use of the digital questionnaires. Electronic patient reported outcome measures, or ePROMs, are collected at a number of points in the care experience for these areas:

Other areas use it for:

  • Anxiety and depression screening
  • 90-day follow-up visit for stroke patients
  • Pre-operative visits for hip or knee replacement

Welcome screen for waiting room IPad ePROM patient scheduled to see Dr. Niazi during this visit.

How does it work?

When a patient checks in for their appointment, the desk staff hands the IPad to the patient. They will see a picture of their doctor, and a personalized greeting. The patient answers some initial questions, and those additional ones that appear as concerns are recognized. (These ‘smart questionnaires’ employ branching logic, which allows the answer from one question to determine what question to ask next, or if certain questions should be skipped. Follow-up surveys also incorporate information from previous surveys to determine what questions are asked).

After they’ve completed the survey, the patient then returns IPad to front desk. Answers are immediately available to the physician in a special inbox. They are shown in a color-coded display, with those issues of most concern marked in red. Doctors then have the information necessary to have a conversation that gets to the heart of the concerns for their patient that day.

The information from the ePROMs doesn’t just stop there. It is added to the medical record, building a more complete picture of the patient that will help not only today’s physician, but other providers they may see in the future. The data is stored in a format that makes it easy to access during medical records research, helping shape care for future patients with the same condition.

The results?

Color-coded results help guide physician-patient conversation.

Patients appreciate the shift from paper to electronic, saying:

“Excellent tool.”

“Very easy and concise”

“This is much better than paper! Easy to understand and absorb.”

“Easy and quick.”

Providers also like the tool, reporting that they have more valuable conversations with patients, and due to color coding, are easily able to focus on the immediate concerns of the patient. Documentation time has been cut in half. Staff members spend much less time is spent prepping packets before appointments or scanning documents after appointments. The general consensus is that ePROMS make their jobs easier.

“While many opportunities exist to use ePROMs, we just getting started,” says Dr. Uitti. “We want to incorporate them in more ways, and deliver them in more venues, obtaining information in the process that helps care for the individual patient today, and improves patient care in the future.”


Tags: About, Center for the Science of Health Care Delivery, Dr. Ryan Uitti, EPROMS, Findings, Florida, Innovations, Kern Center, patient reported outcomes, PROs



Posts: 1
Joined: Feb 09, 2017
Posted by @clayforsberg, Feb 9, 2017

This is a start. Why isn’t this being spread through the Mayo Clinic Care Network though. I’m a cancer patient at Billings Clinic, and let’s say there isn’t much interaction going on between myself and the multiple doctors I’ve had. To get a better idea, here is a blog piece I wrote on my experience as of a year ago. Now I’m in for another round of treatment and I don’t see much improvement on the customer relations front.

Elizabeth Zimmermann

Posts: 130
Joined: Sep 18, 2014
Posted by @elizabethzimmermann, Feb 13, 2017

Thanks for reading our Advancing the Science blog and sharing your thoughts. Mayo Clinic established the Mayo Clinic Care Network to make sharing knowledge and expertise easier among health care organizations and, through collaboration, better serve patients. Your feedback is appreciated, and we wish you all the best as you continue your treatment.


Posts: 1
Joined: Mar 08, 2017
Posted by @sussanbetcher, Mar 8, 2017

We watch Questionnaires very often, as they are distributed to collect opinions and suggestions. In the health field, these Questionnaires are helpful to understand the background and medical history of the patient. Thanks for sharing.

Elizabeth Zimmermann

Posts: 130
Joined: Sep 18, 2014
Posted by @elizabethzimmermann, Oct 25, 2017

New article in Harvard Business Review, highlighting this work at Mayo Clinic (specifically Dr. Niazi’s use of ePROMs), as well as some other groups.


Posts: 2
Joined: Sep 20, 2017
Posted by @alexpaul, Wed, Jan 17 11:10pm

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