The collection and meaningful use of Patient Reported Outcome Measures (PROMs) has its difficulties. Time is cited as one of the biggest barriers to using measures within a clinical setting: the time to collect the information, the time to process the information and the time to get it back in a format that is meaningful and can be used with the child or young person (CYP). Despite the recognised value of outcomes measures, the collection of the information and data input for patient records can be seen as a burdensome duplication of effort in an already time-precious environment.

Unsurprisingly, most trusts are investigating ways to streamline this process and more teams are looking to their IT provision, specifically the hardware used in sessions, for the solution. We wanted to get the story from a trust that has developed their IT hardware to enable better collection at the front end of the process and hopefully share some key points about their journey that others can learn from.

Sheffield CAMHS has two Tier 3 teams which together cover the whole of the Sheffield area, one receiving referrals from the north and west of the city and the other receiving referrals from the south and east. Between them, the two community teams receive around 1400 referrals per year.

The decision was made back in the beginning of 2013, 18 months before becoming a CYP IAPT site, to develop an IT hardware solution to assist staff in collecting measures and for the results of these measures to be fed directly into patient records. The vision was to create a paperless measures system where up-to-date and relevant CYP information could be viewed in the appointment. With this vision in mind, a meeting was held with the developers of the Care Notes system, the Trust’s data manager and representatives from their IT department, to discuss their options and agree on the hardware they would need to progress. iPads got the winning vote and funding was secured in partnership with another trust using Care Notes from the Yorkshire and Humber Strategic Health Organisation.

It was agreed that the first measures to be developed and used on the iPads were the Child Outcome Rating Scale (CORS) the Session Rating Scale (SRS) and Goals; this was the original work that was costed for and delivered by the Care Notes developers. The initial build took four months, which was longer than anticipated. The hold-up was due to issues with the Trust’s version of Care Notes and Internet Explorer. This was something that they were not aware of and so these elements needed to be upgraded before the software and hardware would be compatible; this meant a trust-wide development, no small feat.

After these initial hiccups were dealt with, one team was selected to be trained and pilot the solution. From here it took a further 18 months to identify and make other changes to the virtual processes which were deal breakers to the iPads being fully utilised. These included:

  • Information Governance: making sure other patient records could not be clicked back into during the session.
  • Accuracy of the ORS and SRS line: translating this measure into a digital format meant ensuring that the line was still 10cm and that the CYP could still mark the line at any point (not snapping to the closest point on the iPad grid).
  • Allowing the CYP to be able to press the faces at the extremes of the scales.

During this time, Sheffield became a CYP IAPT site and so it has now started to train and roll out the use of iPads to additional teams.

It has been just over two years since Sheffield started their iPad journey and, although the initiative has had its successes, they still do not have a paperless measures system and the process still needs some tweaks. The clinician, for example, has to schedule the appointment with the CYP on Care Notes and pre-select which measures they will be using during the session; this has to be done before the session and is another thing that the clinician needs to add to their to-do list. They have also recognised that the paper versions of the measures are actually more flexible within sessions, as with the ORS and SRS you can see all four questions at once on the same page whilst on an iPad they are on separate screens and you cannot click back to the previous question.

In summary, if you are thinking of, or have started embarking on, a similar journey Sheffield would say the following:

  • It is a costly process - work with another organisation who has the same patient information system and who has similar needs and aspirations so that you can share the development cost
  • Buying the IT is the easy part – be prepared for a lengthy and resource intensive few years. This project has had their data manager, outcomes team lead and assistant dedicated to this for the last two years, with additional resources being dedicated in the first year
  • Choose one method of collection and stick to it (paper vs IT) and don’t try to run both simultaneously. Sheffield has continued to use paper for some measures because the iPads don’t do everything they want them to but this has caused confusion with staff.