SA Health and the Commission on Excellence and Innovation in Health (CEIH) recently announced the first go-live of the South Australia Statewide Patient Reported Measures (PRMs) Program.

Introduced in 2021, the PRM Program encourages patients to report on their health outcomes and experiences, which clinicians can tap into to make better decisions on their patients' health. It leverages New Zealand-based The Clinician's ZEDOC solution for the near-real-time collection and reporting of PRMs. ZEDOC is currently being integrated into the Sunrise EMR, which is also being rolled out across SA.  

In December, the program went live at the South Australian Medical Imaging (SAMI) Nuclear Medicine Theranostics Service of The Queen Elizabeth Hospital (TQEH) in Adelaide. CEIH PRM Program director Megan Scott walked Healthcare IT News through their experience in this first implementation, highlighting a key success factor in raising clinicians' uptake of new digital solutions. She also detailed how they are maintaining cybersecurity for both patients and clinicians amid growing threats.

Q: Can you walk us through the implementation of the PRMs at TQEH's SAMI?

Scott: Clinicians at the Theranostics Service have been using a digital electronic medical record for nearly 10 years, in addition to multiple other digital solutions. They were exceptionally keen to be early adopters of the ZEDOC solution and had a great level of comfort with the implementation process given their prior experience in implementing digital solutions. As a result, the implementation went very well with the service completing a full outpatient clinic on implementation day and both patients and clinicians using the solution.

The PRM Program team worked with the Theranostics service team to customise their survey project build in the solution specific to their requirements. The process of service discovery, requirements gathering, configuration, testing, training and workflow planning was conducted over approximately 12 weeks in late 2023, with the implementation date occurring in mid-December. Key priorities for the team were understanding their requirements, enabling the visualisation of longitudinal PRM data through dashboards, and supporting new clinical workflows using real-time information as reported by patients.

The service's previous digital survey solution relied on patients to complete the survey while in the clinic waiting room using a hospital-supplied device. With the new solution, survey invitations are sent to patients some days ahead of their clinical encounters, thus enabling the patient to complete the survey in their own time. Evidence indicates that this method reduces pressure for patients and results in better symptom recall by the patient. ZEDOC also allows for near real-time review of the recent survey results and historical responses presented in a longitudinal format, the presence of which enhances partnership and shared decision-making between patients and clinicians during clinical consultations.

Early reports from both clinicians and patients at TQEH SAMI note that ZEDOC is a significant improvement from their previous solution and approach as it provides an excellent user experience for both patients and clinicians and a more streamlined process for collecting and reviewing the data from patients.

As the collection of PROMs (patient-reported outcome measures) forms part of the patient care continuum, they are considered part of the medical record with the relevant South Australian legislative and policy requirements for the handling of medical records in place in the ZEDOC solution. The usage of PREMs (patient-reported experience measures) is considered a quality improvement activity, with survey results being de-identified and used at an aggregate level for the improvement of health services. Patients may opt out of receiving or responding to survey invitations or the program entirely if they so choose. This process is managed locally by each implementing service as well as by patients within the patient-facing elements of the solution.

Q: After TQEH, which services are also slated under the Stage 1 implementation? What do you expect the implementation to look like at those services? 

Scott: While some components for ZEDOC are similar across the board, each clinical service has the opportunity to tailor the solution to meet their requirements. In our experience, offering a degree of customisation enhances clinical adoption and long-term acceptance of the solution. Customising survey messaging and enabling service-designed patient resources within the solution also enhances patient response rates.

Once the PRM instrument has been chosen by the service, the PRM team then work to configure the survey project in ZEDOC based on the requirements. This work includes adding hospital/service logos and branding to the survey, developing patient resources for the ZEDOC FAQ, designing the survey invitation messages, applying the survey milestone configuration (such as when surveys are collected and when invitations are sent), and configuring alerts and response dashboards, as well as broader reporting requirements.

The remainder of our Stage 1 implementations are scheduled to occur during February and March 2024, with our next service (Radiation Oncology at the Royal Adelaide Hospital) having already gone live on 31 January 2024. The remaining Stage 1 implementation also includes:

• select Central Adelaide Local Health Network Rheumatology services;

• Southern Adelaide Local Health Network Plastic and Reconstructive Surgery services, including the Hand Surgery Service, Breast Reconstruction Service, and Facial Skin Cancer Surgery Service;

• select Southern Adelaide Local Health Network Rehabilitation services; and 

• Women’s and Children’s Health Network.

An additional two implementation stages are planned for 2024, with scope negotiations currently underway with SA Health Local Health Networks. Additional stages are anticipated during 2025.

Q: Not long ago local SA Health networks reported a cyber incident affecting their digital patient pathways. With the digital collection of PRMs underway across SA, how do you intend to protect PPIs and other sensitive patient information amid rising cyber threats? How is the PRM Program designed to deal with cyber threats and intrusions?

Scott: The PRM Program has undertaken a significant review of operational, policy, and legislative requirements in relation to the handling of personal information. The ZEDOC solution underwent rigorous security assessments during both procurement and configuration phases and is compliant with SA Health requirements in this regard. Controls are in place to minimise the risk of unauthorised access to the system. Core technical assets are allocated exclusively to SA Health and the solution, providing greater visibility and control of what happens inside them. Meanwhile, the vendor maintains an internationally recognised security certification to ensure operational security competency.

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The interviewee's responses have been edited for brevity and clarity.