Professor Nick Goodwin, from NUS CRIHSP, provided an overview of the Policy Briefing’s main findings to show that implementing PROMs can bring many benefits. At the patient level, PROMs use can improve the quality of clinical decision-making and enable people to improve their quality of life. Evidence also supports how PROMs can drive value-based healthcare initiatives in health systems through performance monitoring, quality assurance, and continuous quality improvement.

The presentations from the three Clusters sought to examine how they addressed the many implementation challenges in using PROMs effectively. Ms Huang Lezhi from NHG Health reported how they envisaged creating an ecosystem for scaling PROMs, but that the journey took several years of essential. This included investment in clinical and technical capabilities as well as governance, but also significant trust and relationship building with clinicians and patients. Dr Jega Pradeeba from NUHS described their approach in co-designing a cluster-wide approach to PROMs implementation and described the need for a ‘whole of system effort’ from identifying the right technologies, to enabling clear clinical workflows, and engaging with clinicians and patients to promote effective PROMs use. Dr Julian Thumboo reported on the experience of embedding PROMs in clinical care at SingHealth to support scaling and maturation. This included critical ongoing challenges in integrating PROMs into EPIC, embedding PROMs in clinical workflows, and overcoming siloed implementation.

During the dialogue, Dr Albert Ty – Director (Value Safety and Performance Division) Ministry of Health – reported that national policy had taken the serious step to ensure PROMs are key reporting metrics in the health system, setting the ‘signal’ for an approach that improves clinical decision making and helps keep patients healthy.

A/Prof Sandra Nolte from Monash University, Australia and Dr Michael van den Berg from OECD reflected on the need for a national policy to invest in data infrastructure and technological standards such that PROMs are embedded within electronic medical records for active use by clinicians across organizations, so to share results between providers and enable real-time analysis and reporting.

Dr Rita Jain from DEBRA International and Dr Laurie Goldsmith from CRIHSP reflected on the report’s finding that patient and public involvement in PROMs was low. They stressed the importance of continuously involving patients across the whole design and implementation process to better capture outcomes that matter to patients, address the potential exclusion of certain patient groups, and provide skilled support to patients in engaging with PROMs.

In terms of whether PROMs should be used in quality assurance, the panel was more cautious. Whilst PROMs were central to quality improvement to specific patient cohorts, using PROMs for accountability, benchmarking and performance management purposes would require increased confidence in data quality and its representativeness. Using PROM as part of a basket of quality indicators to tell whole story was suggested.

These rich deliberations reinforced the key messages of the PROMs Policy Brief that a nationally coordinated PROMs program is necessary to address the many clinical, technical and relational challenges to implementation that exist, and so maximize the opportunity to drive higher value-based healthcare practices.