Operations on patients always have an impact, hopefully for the better, sometimes for the worse. There is variability in outcomes, which can depend on patient factors but can also depend upon the surgical teams that perform the surgery. So that any variability in outcomes in patient groups can be studied and improvements in care made, ‘Outcome Measures’ are collected. These are often patient completed questionnaires to formally score patients pain and function before and after surgery. Patient Reported Outcome Measures are known as PROMs.
Some trusts now routinely collect questionnaires to compare patients’ pre-operative and post-operative scores to inform clinical practice and drive improvement. The questionnaires are normally specific to the operation that has been performed (e.g. knee replacement scores, or hernia scores) and most operations will also have a more general health status score applied as well (known as EQ-5D). EQ-5D can be applied across all aspects of healthcare and is a good way to work out how much impact an operation may have on health compared to say treatment for diabetes. This helps healthcare providers direct money to the interventions that have the most patient benefit.
Trusts currently collect the data in paper format which is then converted into an electronic format for storage and analysis purposes (usually via manual input).
We have chosen to develop a solution will be open source and based on open standards. It will sit either in fully compliant cloud-based servers or could sit within a trust’s own environment meeting all industry standards for security and GDPR. All data collected via the software will be held in an open computable format (openEHR) which will facilitate data analytics and will be designed to interoperate with other hospital systems. Trusts have full real time access to their patient data for analysis, data is protected as per the trusts governance policies.
There are commercial options available, these routinely cost each NHS trust up to £50,000 PA. Instead, we can do this collectively, reduce cost and deliver a best in class solution designed by its users. To take the work forward we have created a Committee under the governance of the Apperta Foundation. We are asking others to get involved and collectively fund the target of £150,000 capital to finish the product build. We estimate future costs to be £10k 'one off' implementation per trust/hospital and approximately £15k for annual support, maintenance and membership to the committee.
Progress to Date
We’ve created an alpha solution with support from the Code4Health initiative and its partners. This has basic functionality for inputting patient and procedure data using Foot & Ankle as the use case and was tested internally at Northumbria Healthcare. There is also the facility for a basic data export into Excel for analysis.
We are now ready to move forward; the next phase will add other specialty modules and further functionality.
Orthopaedic questionnaires which have now been written as archetypes ready to be incorporated into the platform are...
- Foot & Ankle – MOXFQ, AOS, AOFAS, SAFAS, VISA-A, ATRS
- Upper Limb – OSS, OSIS, OES, Boston, PEM, URAM, QDash
- Hip – OHS, iHOT12, NAHS
- Spine – NDI, MDI, ODI, VAS back & leg, VAS arm & neck
- Knee – OKS, OKS (A&P), KOOS, Tegner, IKDC
- General MSK - MSKHQ
- General health– EQ-5D, Pain VAS, Patient Satisfaction
We plan to add several other features, including...
Additional methods to input outcomes
- Tablets or PC browser entry by the patients in clinic within the hospital’s intranet
- Web and smartphone / tablet entry via the internet
- Text responses
- The ability for the software to generate bar coded questionnaires so they can be automatically posted out to patients and automatically read when returned and ascribed to the correct patient and operation/intervention.
- Automatic prompts when post-operative responses are due
- Prompts when questionnaires have not been received
- Reporting module
- Ability to analyse data and view charts, graphs, and tables with a variety of queries possible. This will allow real time data to be available to clinicians and teams within hospitals.
- Data push into national registries
- Ability to push data into the various national registries to avoid duplication and save time.
Over to you
We want clinicians and their departments to get involved, subscribe to use the product and help to shape its future. Subscribers will be asked to take a seat on our committee if they so wish, to govern product development and to decide how future investment should be spent.
Our Committee Members
Professor Mike Reed is a consultant trauma and orthopaedic surgeon for Northumbria Healthcare NHS Foundation Trust. Following medical school in Newcastle and his MD in Sheffield, Mike trained in trauma and orthopaedics in the North of England, and completed fellowships in New Zealand. Currently, he is a full-time hip and knee replacement surgeon, with trauma commitments within a busy Trauma Unit. At Trust level, Mike has run improvement programmes in hip fracture care, infection prevention and enhanced recovery. He is the Clinical Director at Northumbria leading a high performing team, supported by a group of committed and talented colleagues. His research, supported by industry, charity and government funding, focuses on clinical outcomes and on his specialist interest in infection prevention, diagnosis and management. With Northumbria, he is leading large national collaboratives on hip fracture care and enhanced recovery. In addition, Mike supervises basic science research at Newcastle University, which focuses on vitamin D and infection. He is also Chief Investigator for clinical trials on clinical outcomes and infection prevention at the Universities of York and Oxford.
Ajay Malviya is a Consultant Orthopaedic Surgeon at Northumbria Healthcare NHS Foundation Trust. He trained in the Northern Deanery and has done specialist fellowships in hip preservation and joint replacement surgery in Cambridge, London and Switzerland. He is an expert in hip arthroscopy for femoroacetabular impingement, trochanteric pain syndrome and periacetabular osteotomy for hip dysplasia using a minimally invasive approach. In his routine practice he deals with sports injuries of the hip and has published and presented widely on the results of hip arthroscopy in athletes and general population. He has completed a PhD on the role of hip arthroscopy in femoroacetabular impingement. Preservation of the hip joint is his principle philosophy but he has a wide experience of joint replacement surgery catering to the young population, if necessary. Ajay also serves as a board member for the Non-Arthroplasty Hip Registry and is an advocate of the use of PROMs data to inform clinical practice.
Anji has worked in healthcare for over 30 years and for Northumbria Healthcare NHS Foundation Trust for 15 years. With a combination of clinical and administrative experience she has been developing and running the trust’s elective orthopaedic PROMs programme for 5 years. Anji is passionate about PROMs and using the resulting data to improve patient care and inform clinical practice. She feels that openOutcomes would provide a practical solution to recording and using PROMs and enable ongoing collaborative development to accommodate future requirements.
Kanthan qualified in medicine from Imperial College London in 2003 and obtained a BSc in Orthopaedic Science from University College London in 2001 whilst an undergraduate. He completed his Orthopaedic training in Birmingham and specialist fellowship training in shoulder and upper limb surgery in Derby & Wrightington. He is a Consultant Orthopaedic Surgeon at Sandwell & West Birmingham Hospitals NHS Trust since 2016 and is the Upper limb and Research lead within the department. He sits on the R&D committee for the trust. Mr Theivendran is an Honorary Professor at the School of Engineering and Applied Science, Biomedical Engineering Research Unit at Aston University and an Honorary Senior Lecturer in Orthopaedic Surgery at Aston Medical School. His interests include Clinical trials, Biomedical Engineering and patient reported outcome measures (PROMs).