Health Systems and PROMs Data: Screening Readiness
January 14, 2026
5 min read
PROMIS works well in orthopedics, but its value extends far beyond our specialty. The same PROMIS platform can assess symptoms such as sleep disturbance, cognitive function, anxiety or self-efficacy in other clinical settings. These results can be viewed in the electronic health record at the time of the visit, making it actionable for clinicians. That same infrastructure can then be used in clinics, such as dermatology, simply by selecting different symptom domains. This is how PROMs can truly move across an entire health system.
One of the major concerns clinicians raise is the growing linkage between PROM collection and payment. Many worry that the PROMs collected now for joint replacement and tied to reimbursement do not reflect the enhancement seen by the patient. It might potentially be as CMS has chosen specific anatomic PROMs to assess outcomes after joint replacement surgery. there is currently no versatility to use alternative instruments that could be crosswalked to these anatomic measures, such as PROMIS.compounding this concern, the vetting process for these anatomic instruments was not open or globally inclusive.
PROMIS has been widely adopted in orthopedics, and many orthopedists are far more familiar with it than with instruments such as the Hip Disability and osteoarthritis Outcome Score or the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement. Yet clinicians are now being asked to collect, interpret and be judged solely on these anatomic measures. This is challenging because many surgeons do not know how to interpret HOOS or KOOS JR scores at the level of an individual patient, and that discomfort is amplified now that these measures are tied to reimbursement. CMS will likely need to revisit these decisions and consider allowing other validated instruments to contribute to outcome assessment, so clinicians can feel confident that we are measuring what truly matters to our patients and doing the right things for their care.
I frequently enough return to the age-old adage: if you do not measure it, you cannot manage it. Orthopedic surgeons frequently say, ”I know my patients, I know they are improving.” And while we do listen carefully to our patients, the reality is that we do not ask the same questions, in the same way, at every visit when it matters most for their care. Without that consistency,variation in care is certain and often invisible.
You cannot truly understand variation unless you are asking a consistent set of questions through time. My hope is simply that we achieve greater consistency so patients can better understand where they fall in terms of symptom severity and what response they might expect from a treatment or surgery we offer. If we improve consistency, we can reduce unwarranted variation and, ultimately, decrease health care costs while improving patient-centered care.
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Judith F. Baumhauer, MD, MPH, is a professor of orthopedic surgery and vice dean for academic affairs at the University of Rochester School of Medicine and Dentistry. She wishes to be contacted through Barbara Ficarra at barbara_ficarra@urmc.rochester.edu.
PROMs collection presents with challenges
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PROMIS Scoring System Improves Patient-Reported Outcomes in Orthopedics
The PROMIS (Patient-Reported Outcomes Measurement Information System) scoring system is increasingly utilized in orthopedic practice to objectively measure and track patient-reported outcomes, leading to more informed clinical decision-making and improved patient care.
What is the PROMIS System?
The PROMIS system is a set of standardized questionnaires designed to measure various aspects of physical, mental, and social health.It was developed by the National Institutes of Health (NIH) to provide reliable and valid measures of patient-reported outcomes, addressing limitations of previous outcome tools.
Initially funded in 2004, the PROMIS initiative aimed to create a modular system allowing clinicians to select relevant measures for specific conditions and patient populations. The system utilizes computer adaptive testing (CAT) and fixed-length short forms to efficiently assess patient health status. according to the PROMIS Health Association,the system now includes over 200 health measures.
How is PROMIS Used in Orthopedics?
In orthopedics, PROMIS is used to assess a patient’s functional limitations, pain levels, and overall quality of life before and after treatment for conditions like hip and knee osteoarthritis, shoulder injuries, and spine disorders. This data helps surgeons and other healthcare providers understand the impact of these conditions on patients’ daily lives and monitor their progress following interventions.
For example,a patient undergoing total knee replacement might complete PROMIS questionnaires before surgery to establish a baseline,and then again at regular intervals post-operatively to track improvements in pain,mobility,and function. researchers have demonstrated that PROMIS scores correlate well with other established outcome measures, such as the Knee Society Score and the Harris Hip Score.
Benefits of Implementing PROMIS
Implementing PROMIS offers several benefits for both patients and providers. It provides a standardized, objective way to measure outcomes, reducing reliance on subjective assessments. This allows for more accurate comparisons of treatment effectiveness across different patients and practices.
A study published in Arthritis & Rheumatology in 2023 showed that using PROMIS scores to guide treatment decisions in patients with hip osteoarthritis led to a 15% improvement in patient-reported function compared to standard care. Furthermore,PROMIS data can be used to identify patients who may benefit from more intensive interventions or alternative treatment approaches. Baumhauer and Higuera-Rueda, experts in the field, emphasize the system’s ability to capture the patient’s outlook, leading to more patient-centered care.
Challenges and Future Directions
Despite its benefits, PROMIS implementation faces challenges. These include the time required for patients to complete the questionnaires and the need for training healthcare staff on proper administration and interpretation of the scores. Integration of PROMIS data into electronic health records (EHRs) is also ongoing.
Future directions for PROMIS include the development of new measures for emerging orthopedic conditions and the use of PROMIS data in conjunction with other data sources, such as imaging and genetic information, to personalize treatment plans. The PROMIS Health Organization continues to refine and expand the system based on ongoing research and clinical feedback.