Canton Hospital Winterthur // Switzerland
How the Canton Hospital Winterthur uses UNITY to streamline patient outcome measurement
Challenge
To measure quality indicators as well as patient-reported outcomes, the Canton Hospital Winterthur (KSW) required an all-in-one patient survey solution that adapts to existing clinical workflows.
Solution
Using UNITY, the hospital has been able to digitalize patient questionnaires like ePROs and ePREMs, including the integration of results into electronic health records (EHRs).
Results
With the solution, the hospital can gather valuable outcome measurements to improve quality of care without additional staff. Tedious and error-prone administrative tasks have also been eliminated, saving the hospital 6 figures each year.
Excerpt
Normally, collecting outcome measurements, such as PROMs and PREMs, means loads of paper, additional staff, and arduous data entry tasks.
But the Canton Hospital Winterthur (KSW) has been able to automate patient questionnaires fully. Find out how they did it below.
Challenge: Outcome measurement in routine clinical care
List hospitals in the Canton of Zurich are required by the Zurich Department of Health to adhere to strict regulations for the continuous collection of quality indicators. Data must also be transmitted to various medical registers for clinical research – a time-consuming administrative task.
In addition to legal obligations, the KSW strives for continuous improvement of quality indicators that holistically and evidence-based assess a patient’s health status.
To achieve these goals, more than 20,000 patient surveys, such as patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are conducted each year.
The hospital's requirements
The implementation of PROMs and PREMs into clinical routine care is a complex task.
Because PROMs and PREMs were originally used as paper questionnaires in controlled clinical studies, not in daily clinical operations. Challenges include avoiding data silos and reducing the need for administrative and technical personnel.
The KSW was aware of these challenges when it began planning to integrate patient surveys into routine care. The planning process included a thorough market analysis and an in-depth evaluation by a multidisciplinary committee. Three main criteria were developed for the software solution:
• Interoperability
• Automation
• User-friendliness
Seamless integration
It was crucial that the solution could be seamlessly adapted to clinical workflows without additional administrative tasks.
“We wanted to introduce PROM questionnaires in the most resource-efficient way possible,” says Susanne Imhof, Head of Quality Development at the KSW.
Hiring administrative staff and reconfiguring workflows was not an option for the hospital. Since a change of hospital information system (HIS) provider was imminent, the solution had to have flexible integration capabilities. The high volume of data collected in patient surveys required a smooth transition and continuous use.
Customizable and standardized questionnaires
The hospital also needed a comprehensive catalogue of questionnaires.
Clinical personnel would be employing these in diverse clinical applications, so the following criteria were important:
- access to an array of standardized PRO instruments,
- individualizable PREM questionnaires that align with a patient’s individual journey
- customizable in- and out-patient surveys
Solutions from other providers lacked the depth and breadth in their selection of questionnaires, offering, for instance, “only PRO surveys that could only be configured by the system vendor.”
Solution: UNITY as an interoperable, automated patient questionnaire management tool
Minimal IT maintenance
The KSW project managers opted for a solution that offers a high degree of interoperability and data security while relieving the hospital’s IT department of maintenance and cyber security tasks.
Today, it serves as a powerful questionnaire management tool in the hospital. It automates many of the administrative tasks associated with collecting and processing data from patient questionnaires.
"Another important function is direct access from our EHR system. This makes it easy to check the survey status at the reception desk. Likewise, for the medical staff, a view of a patient's survey results is just a click away from the patient's file.”
– Susanne Imhof, Head of Quality Development at the KSW
Automated patient questionnaire administration and integration
One of the outstanding features of UNITY for the Swiss hospital is its connection to the hospital information system (HIS) through an interface.
“The automatic allocation of patients to survey sets, the sending of emails and reminders, the easy access to data through the KIS, and the transmission of data to the registers reduce the workload of clinically active personnel,” says Nathalie Eggenberg, Quality Development Employee at KSW.
The RAYLYTIC solution, for example, manages the corresponding questionnaires for the patients. Depending on the treatment or type of hospital stay, patients are automatically provided with predefined questionnaires.
Automated integration of ePROs into national implant registries
The hospital is legally obligated to transmit PROM data to medical registers, such as the Swiss Implant Registry (SIRIS) or Adjumed. With UNITY, doctors can electronically document all the necessary data for SIRIS, which is then transmitted to the register. At the same time, the questionnaires are stored as PDF files in the hospital’s KIS, allowing the hospital to use them internally.
In this way, doctors not only avoid additional administrative work and unnecessary data entry, but also meet legal requirements.
Integration with scheduling software
Thanks to the integration of UNITY with the hospital’s appointment scheduling, patients can fill out the questionnaires at the right time according to planned and changing appointments. A few days before the planned hospital visit, patients receive an email notification reminding them to fill out their questionnaire from home.
Most patients have their results available at their next hospital visit. The remaining patients can fill out the questionnaires on a tablet as soon as they arrive at the hospital.
Outcomes
Saving time and resources
The collection of patient questionnaires in digital form facilitates the flow of data between the involved systems. “With the use of UNITY, the basis was laid for not having to maintain or introduce an unlimited number of individual solutions for the processing of PROMs and PREMs. This relieves IT managers in the long term,” says Daniel Wunderli, IT project manager.
In addition, the number of paper forms has been reduced. The transition to fully digitized processing of questionnaires has contributed to cost savings in the six-digit range for postage, printing, and scanning.
Future expansion of ePROs use
Thanks to the high degree of automation, many different types of PROM questionnaires can be easily used in many different clinical departments. In this way, the use of the UNITY platform has helped to eliminate persistent uncertainties about the feasibility of PROMs and PREMs as part of routine clinical care. Due to the reliability and simplicity of the solution, the hospital plans to roll out to further departments.