Routine Outcome Monitoring as a vital quality tool for Emergis

And the use of VitalHealth QuestLink® in it

Interview with Niek de Klerk, staff member at Emergis 

Emergis 250pxRoutine Outcome Monitoring (ROM). A vital tool for quality improvement? Or perhaps more a lever used by health insurers? Although the latter sometimes seems to be the case, at Emergis they know better. One of their challenges for 2013 is to demonstrate the versatility of ROM and to show that it offers much more than a means of submitting data to the SBG, the Dutch Mental Health Care Association Benchmark Foundation. Niek de Klerk works for Emergis, a Dutch Mental Health Care institution that treats and counsels approximately 11,000 people annually. He explains the significance of ROM for Emergis, what the related tasks are for its staff members and how VitalHealth QuestLink as a ROM application functions in all this.

ROM as most important record

The entire Emergis ROM record is managed by its knowledge center. Niek de Klerk works on several other important records such as quality management, risk analysis and an electronic patient portal, but the ROM record for him is the most important of all, both in terms of complexity and scope. “There are several other disciplines that actively support this record. They include the knowledge center researchers conducting outcomes research, data analysts supplying data to the SBG, the regular IT support desk that answers questions on QuestLink and of course all of the departments that work with questionnaires.” Niek says. At Emergis, almost all of the departments work with ROM questionnaires. Emergis specializes in the treatment of mental and addiction-related disorders as well as provides social and work counseling, social relief and forensic care. These services are provided for all age groups at and from fifty different locations in the province of Zeeland, both in the second line and via Indigo, a first-line organization that belongs to Emergis. Logistically, all use of ROM is therefore mostly supervised by secretarial departments at the healthcare program level.

Making choices

Getting started with ROM and the ROM application QuestLink in an organization as big as Emergis, also meant that choices had to be made. Several requirements were set by the SBG for working with ROM, and the most logical choice was to first process all of the obligatory questionnaires. The questionnaires specifically requested by professionals were only added at a later stage. “We currently work with sixteen different questionnaires, twelve of which were taken from the SBG and four of which are own selections. The expectations are that the own selection category will increase in scope, for example with the inclusion of specific anxiety disorder questionnaires and depression or relationship-related questionnaires that can play a significant role in assessing the patient’s health status at the beginning, halfway through and towards the end of his or her treatment. The results can then be discussed with the patient during treatment.”

Another choice made by Emergis was to have the logistics surrounding the use of questionnaires, which includes tasks such as dispatching them and follow-up calling, managed by the secretarial office. “This gives the practitioners more time to spend on treatments, but we also do not want to take away those tasks from them entirely. The reason for this is that we see practitioners and patients alike becoming increasingly aware of the advantages of discussing the results if the lists are used during treatment. This way, both are motivated to use the system, which in turn of course has a positive effect on both response and the quality of healthcare.” Niek explains.

Link to the Electronic Health Record (EHR) of Emergis

QuestLink is currently mainly used by Emergis for processing ROM questionnaires, for which it is linked to the organization’s EHR. Niek: “Staff members therefore only need to use a single tool. The EHR contains a separate file tab under which all of the ROM results entered into the system via QuestLink can be viewed. Our intention is to also apply QuestLink for diagnostic questionnaires in the near future, thus making them easier to use.”

The hurdle in supplying the SBG

Organizing the stream of data to the SBG was a complicated affair. The SBG sets strict requirements, which is understandable in view of their responsibility for generating reliable benchmark data. The data sets partly originate from QuestLink, partly from the EHR. In order to achieve an optimal fiow of information, the data from the various sources must therefore be matched. “As we have our own data analysts, we decided to automate the flow of data ourselves. Now that we have successfully set up the system, all information is sent to the SBG fully computerized.” Niek says. The SBG sometimes requires very specific data sets from the used questionnaires, which meant that ROM providers such as VitalHealth had to make adjustments to their systems. Niek: “VitalHealth responded very professionally, creating room for discussion and even contacting the SBG themselves to have the requirements explained in detail. Their conduct helped create a pleasant concerted action, one on which we look back with satisfaction.”

Vision of the future

Niek continues: “In the past period, we have sometimes found ourselves in a dilemma due to the speed of developments taking place in ROM as a result of the pressure exerted by insurers. This has led to skepticism on the part of some practitioners with regard to ROM, despite the fact that it is much more a vital tool for quality improvement than a means of complying with legal obligations.” There is also a group of practitioners who are fascinated by the possibilities that ROM offers. These practitioners and others are increasingly making an effort to enthuse the skeptics for the system. “This obviously demonstrates the significance of ROM as an important tool for quality improvement.” Niek says.

What occurs is that mini conferences are organized at which third party speakers explain how practice demonstrates the usefulness of ROM or which reports on the subject are given by officials from satisfied departments using the system. Other possibilities include making publications available and using recent ROM results during the evaluation of treatment results. Niek concludes that “The entire ROM file is incredibly dynamic, and the necessity for the further development of an application like QuestLink and extending its functionalities is therefore considerable. VitalHealth has proved to be a pleasant and reliable partner in this. They have a pro-active attitude, which suits us very well, and they are open to development in line with user requirements. We are very satisfied and our expectations for future cooperation and development are positive.”

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