Routine Outcomes Monitoring and Precision Guided Care

Clinicians want to know how their patients are doing in treatment and many have considered using a Routine Outcome Monitoring (ROM) system, also know as Measurement Based Care or Feedback Informed Treatment. Clinical leaders such as Bruce Wampold argue that ROM “has come of age” and should now be standard practice.* And the health care industry and regulators promote ROM through a new CPT code, 96127, that reimburses outcome measurement and the MACRA/MIPS quality program for Medicare providers.

Yet ROM has not been widely adopted. Surveys show that only a fraction of clinicians (11% of psychologists/18% of psychiatrists) use standard measures in their practices.
We think adoption is low because clinicians do not see the clinical value of ROM as great enough and/or the cost and administrative hassle is to high. So, we designed Precision Guided Care to increase the clinical value of ROM and reduce the cost/administrative burden.

Clinicians told us standardized measures were not patient-specific enough. They wanted to know how patients were doing with respect to the symptoms and goals that brought them to treatment. So we add brief daily monitoring to track those symptoms and goals. These ratings can extend therapy beyond the office visit, promote insight and behavior change (footnote on EMA research) and enhance the therapeutic alliance.** Therapists who use homework assignments wanted a better way for patients to report their activity, so we let them add custom items to the daily ratings. And prescribers can use daily ratings to monitor compliance and side effects of medication.

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We reduce the cost and burden of ROM, first, by making it free for behavioral clinicians and, second, by automating it with technology. Today about 90% of Americans under 50 have a smartphone, a remarkable data collection device. A smartphone alert prompts the patient to complete assessments outside the clinical setting, so there is no interference with the office visit. All the clinician needs to do is select or create daily questions.

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We will be adding new features and enhancements to this product. We selected the PHQ-9 and GAD-7 for our initial outcome measures. These are widely used by primary care and part of the MACRA/MIPs program, so they facilitate behavioral/primary care integration. Also, they are reimburseable with CPT code 96127. We will be adding additional outcomes instruments, including specialized ADHD and substance abuse measures. We welcome feedback from clinicians.

The PGC app is a module in CarePaths EHR. It is also available for free to behavioral clinicians who do not use the CarePaths EHR. You can sign up for it at www.precisionguidedcare.com.

*Wampold, B.E. Routine Outcome Monitoring: Coming of Age—With the Usual Developmental Challenges. 2015. Psychotherapy. Dec;52(4):458-62.

**Daily monitoring is supported by a theoretical model called ecological momentary analysis.  See this link for a meta-analysis of ecological momentary inventions in mental health: www.jmir.org/2016/6/e152

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New Features Added: FAX, Mobile Outcomes, FAQs

Fax

You can now fax clinical documents from Carepaths. To use this feature go to Staff member drop down > clinical OR patient chart > clinical > click fax at the top of the page > sort by patient name, date, etc. > check the box by the record you wish to fax (you can fax one document at a time)> put in fax recipient’s fax number etc> send fax. You can check the fax log to see the progress of your faxed document.

Mobile Assessment and Outcomes

Progress can now be monitored via a mobile phone. We call this feature Precision Guided Care as it extends outcomes monitoring to include daily assessments. Mobile assessments and daily tracking requires the clinician to setup the patient and the patient to download the CarePaths app to enter data.

Clinician selects items for daily monitoring. From within a patient’s record, select Clinical from the dropdown under the patient’s name in the light blue area. Then select Monitoring under the patient’s name in the light blue area. Click Edit Check-In Questions. Select a question from dropdown list. Today’s date and a month later will appear as start and end dates. You can edit these if you wish. Click Add. Add additional questions up to maximum of four.

You can also create your own questions. Select Monitoring in the white area above the patient name. Click Manage Monitoring Questions. Enter your item and add. You can edit or delete items that you have entered, but you cannot edit or delete system items.

Clinician can view results by going into patient’s record, selecting Clinical from the dropdown under the patient’s name and then selecting Monitoring.

The patient needs to download and install the Carepaths app on their smartphone. The app is available in the Google Play store the Apple Store. Once the app is installed the user enters their Carepaths user name and password. This will take them to the patient portal where they can select Progress Monitoring and Tracking. They will then see a page with the results of assessments they have already completed. This page has links for New Daily Check In and Weekly Tracking. Patient should select and complete New Daily Check In and then select and complete Weekly Tracking.

Once the patient has completed the initial assessments they will begin receiving reminders on their phone to complete followup assessments. Reminders go out at 6PM eastern time (5PM Central, 4PM Rocky Mountain and 3PM Pacific). Reminders for daily assessments go out 1 day after the last completed assessment. Reminders for weekly assessments go out 7 days after the last completed assessment.

Patients can also complete assessments by logging into the Carepaths EHR.

FAQ/HELP

We have updated our help section. You can now filter by category and sort by date or alphabetical. To use this function click Staff Member drop down > Help > Guides. We will be adding to this section on an ongoing basis to update and add new information.