Use of SMS and tablet computer improves the electronic collection of elective orthopaedic patient reported outcome measures

Abstract

INTRODUCTION Electronic patient reported outcome measures (PROMs) enable real time reporting back to the patient and medical team, comparison between similar patient cohorts and long-term cost effective outcome measurement. The primary objective of this three-phase pilot study was to measure uptake using a web-based PROM system following the introduction of two separate process improvements. METHODS Eighty consecutive new elective orthopaedic patients in a single surgeon's practice were recruited for the study. Patients in Group 1 (n=26) received only a letter reminding them to complete a symptom score. Those in Group 2 (n=31) also received a reminder SMS (short message service) message via their mobile or home telephone and those in Group 3 (n=23) also had access to a tablet computer in clinic. RESULTS The mean patient age in Group 1 was 55 years (range: 24-80 years), in Group 2 it was 60 years (range: 23-85 years) and in Group 3 it was 58 years (range: 37-78 years) (p>0.05). Overall, 79% of patients had internet access, and 35% of Group 1, 55% of Group 2 and 74% of Group 3 recorded an electronic PROM score (p=0.02). In Group 3, 94% of patients listed for an operation completed an electronic PROM score (p=0.006). CONCLUSIONS Collecting PROM data effectively in everyday clinical practice is challenging. Electronic collection should meet that challenge and improve healthcare delivery but it is in its infancy. This pilot study shows that the combination of an SMS reminder and access to a Wi-Fi enabled tablet computer in the clinic setting enabled 94% of patients listed for an operation to complete a score on a web-based clinical outcomes system. Additional staff training and telephone call reminders may further improve uptake.

Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis

“… 20–22 Gurland et al 20 trialled the use of tablet devices to capture ePROMs on 103 patients in a colorectal surgical clinic and reported an improvement in the PROMs capture rate from 25% (with a paper system) to 96%. Roberts et al 21 reported a pilot study on elective orthopaedic new patients. When patients were asked, via the post only, to complete ePROMs at home, the completion rate was only 35% (26 patients).…”

“…However, when patients were also offered the opportunity to fill out PROMs in clinic on a tablet device, the completion rate improved to 74% (23 patients). 21 Palmen et al 22 emailed 24 patients postoperatively asking them to complete ePROMs online and found poor completion rates of 33%. In contrast, we found a preappointment completion rate of 50.1% and achieved an overall completion rate of 85.9% with much larger numbers and put this down to the way in which our pilot was part of a complete service improvement agenda and not an isolated technology ‘add-on’.…”

Socioeconomic deprivation and age are barriers to the online collection of patient reported outcome measures in orthopaedic patients

“…A report on UK orthopaedic practice published in 2014 showed that a strategy combining reminders with using 'tablet' computers for the completion of PROMs in clinic achieved a 94% completion rate for preoperative PROMs. 12 It is not clear how this would translate to postoperative collection. A study in America demonstrated a poorer response rate for patients in the Medicare or Medicaid schemes, those with total knee replacement or revision arthroplasty, those aged over 75 years and those with ethnic minority status.…”

“…8 Other routes of electronic collection have also been investigated. 12 The aim of our study was to describe the availability of internet access among orthopaedic patients and identify factors associated with limited access.…”

Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer

“…Frequently discussed problems in assessing electronic PRO data include patient age and related computer literacy [10,[21][22][23][24], as well as the additional time and burden for the patient and healthcare institutions in supplying electronic devices and giving instruction on their use [22,[25][26][27][28][29]. However, this study showed that age was not a factor.…”