Patient-Reported Outcomes – Orthopedic (Hip & Knee)

If you are having elective hip or knee (orthopedic) surgery, it is important to let your health care team know regularly how well you are feeling. You can fill out a survey each time you visit the clinic or as instructed by your health care team. This survey sometimes is called “PROMs,” for patient-reported outcome measures, or “ISAAC,” the name of the electronic platform you use to access the survey.

The survey asks about your level of pain, your functional status (how well you manage daily life), your overall quality of life and your orthopedic care.

All people who are having elective hip or knee surgery should complete the survey before and after surgery.

Why You Should Complete the Survey

You do not have to complete the survey if you don’t want to, but there are some benefits to doing it:

• The information helps your health care team plan the best possible care for your unique needs.
• Your answers measure how well you are doing before your surgery and how well you are healing afterwards.

Doing the survey before and after surgery means that you and your health care team can track your progress over time.

About the Survey

It only takes about 5 minutes to complete the PROMs survey.

Complete your PROMs:

• during your pre-surgical visit to the clinic (within 2 months before your surgery)
• within 3 to 5 months after your surgery
• within 9 to 15 months after your surgery

The survey is available electronically in English and French, and in more languages on paper. Let the clinic staff know if you need to complete the survey in a language other than English or French.

The electronic platform where you access the survey, called ISAAC, is available on tablets and kiosks at hospitals across Ontario. Once you are registered in ISAAC by the clinic staff, you can complete the survey at clinic visits or online from anywhere, including your home.

1. Using any electronic device that has internet access – such as desktop computer, laptop, tablet, iPad or smartphone – go to  promsortho.ontariohealth.ca.
2. Enter your Health Card Number (no letters, no spaces) OR Medical Record Number (MRN).
3. Complete the survey.

If you do the survey, you must answer all of the questions. You cannot skip ahead in the electronic survey. You will have to answer each question to get to the next one.

To change one of your answers while you are doing the survey, click the ‘Back’ button at any time to correct a response. Once you submit your survey you cannot change it, but the registration desk staff at the clinic can do this for you.

Need Help with the Survey?

Clinic staff can show you how to use the tablet, kiosk or your personal device to complete the survey while you are at the clinic.

Please talk to a member of your health care team if you would like to see or change your past symptom scores.

Your Privacy is Important to Us

The information you give through your PROMs is collected and stored in a system called ISAAC (Integrated Symptom Assessment and Collection). ISAAC is a secure web-based electronic platform. Only clinical staff directly involved in your care and ISAAC administrators can access the responses from your personal survey.

We use an anonymous version of the information to report to the Ministry of Health about patient-reported outcome trends. Your information is combined with the information of other patients treated in the clinic to see if there are any trends and for the purpose of quality control and provincial reporting.

If you have completed the electronic survey on ISAAC and you no longer wish to share your personal health information and previous responses, your hospital can remove your information from the ISAAC system. The hospital may keep a copy of your information according to their hospital’s policy. Please contact the hospital registration desk for more information.

Questions?

If you have questions about the patient-reported outcomes survey or the ISAAC tool, your health care team or the registration desk staff can help.

All patients having a consult for elective hip or knee surgery in Ontario should have an opportunity to complete the Patient Reported Outcomes Measures (PROMs) survey.

Here you will find information for health care providers about the survey and the system (called “ISAAC”) used to collect the data.

For an overview of the program and purpose, see Patient-Reported Outcomes – Orthopedic (Hip & Knee).

For information to share with patients, including how to complete the survey, see Hip & Knee Patient-Reported Outcomes Survey.

PROMs Data Collection

Information collected through the PROMs survey

• One question identifying the patient’s joint and laterality of focus
• Three types of PROMs
  • Oxford Hip Score (12 items)
  • Oxford Knee Score (12 items)
  • EQ-5D-5L (6 items)
• One question assessing the patient’s general health
• One question assessing the patient’s satisfaction with care

When to capture PROMs

Mandatory PROMs collection times:

• Pre-surgical assessment (within 2 months before surgery)
• Post-operative assessment (within 3 to 5 months post-surgery)
• One-year post-operative assessment (within 9 to 15 months post-surgery)

*Collection at the Rapid Assess Clinic (RAC) is optional.

Talking to Patients About PROMs

Completing the survey

• On average, it takes patients approximately 5 minutes to complete the survey.
• Patients are required to complete all questions on the ISAAC electronic platform. Answers are saved automatically after each of the 3 types of PROMs is completed.

Making corrections in ISAAC

• While completing the surveys on ISAAC, patients can select the ”Back” button to correct a response at any time.
• Once they select ”Submit,” patients cannot go back and correct their responses in ISAAC.
• If the patient requests it, the site-level administrator(s) can make changes to patient survey responses through the ISAAC administrative portal.

Encouraging patients to complete the PROMs survey

Here are some things you can tell patients to get them to complete the survey:

• PROMs complement existing clinical tools and give patients a chance to tell their care providers how they are doing.
• PROMs allow care providers to track a patient’s progress over time and can be actively used during the patient’s clinic visit.

Refusing to complete the PROMs survey

• Patients are not required to complete the PROMs survey, but sites are required to offer them the opportunity to do so at each of the specified times (see: When to capture PROMs). If a patient refuses to complete PROMs, this is no fault of the clinical team. The patient can proceed with their clinic visit without completing PROMs.
• There is no centrally reported PROMs response rate indicator linked to funding. Clinics or hospitals will not be penalized for patient refusals.

Promoting PROMs survey completion outside of clinic visits

If patients are not visiting the clinic for their post-operative assessments, try these strategies to promote PROMs survey completion:

• Include the survey URL and date required for completion in a patient’s appointment card.
• At the patient’s first visit, ask for their consent to send survey reminders by email.
• Call the patient to remind them to complete the survey.
• Mail a paper copy of the survey to the patient.

Languages available

• The PROMs survey is available electronically on ISAAC in English and French only.
• Hospitals can provide paper copies of the PROMs survey in selected other languages.

Patient Access to the Survey Through the ISAAC (Interactive Symptom Assessment and Collection) System

Specific clinic registration required for access to ISAAC

Each kiosk with the ISAAC system is registered under a specific clinic site. To access a kiosk, the patient must be registered at that clinic.

Completing PROMs surveys in ISAAC at home

• Patients can complete the PROMs survey on any electronic device (at home or clinic) connected to the internet by visiting promsortho.ontariohealth.ca.
• ISAAC is safe to use from home because it is a standardized and secure web-based tool.
• The first ISAAC screen asks patients to enter their 10-digit Health Card Number (no letters, no spaces), or their Medical Record Number (MRN).
• Patient responses from home will be available in real-time through the ISAAC Administrator portal.

Clinical and Administrator Access to PROMs Data in ISAAC

Access to patient-level data in ISAAC

• The hospital’s information technology super users, clinicians and other staff directly involved in clinic flow or patient care should have access to PROMs data.
• ISAAC is a secure web-responsive electronic platform. Access to patient-level information is granted according to a Local Registration Authority (LRA) model, as outlined in the Service License Agreement. The LRA will grant a login user account to ISAAC Administrators, who will, in turn, grant access to real-time patient-level PROMs data.

Requesting access to the ISAAC administrator portal

• To request access, contact your facility’s designated Local Registration Authority (LRA), appointed by the facility’s legally responsible person.
• The LRA is responsible for performing user identity checks, completing and submitting the ISAAC User Registration Form to the ISAAC mailbox.
• Our Service Desk will process the submitted registration form after the ISAAC Team confirms that it is complete. The Access Control Team will then create the accounts and provide each new user with a security pin to access the ISAAC Administrator portal.
• If you have questions about the request process or need help to identify your facility’s LRA, please email the ISAAC mailbox.

Withdrawing patient information and historical responses from ISAAC

• The patient should contact the hospital registration desk to withdraw from ISAAC. The hospital’s ISAAC administrator(s) can notify the ISAAC product team by email.
• The ISAAC product team will remove all requested data and records in the ISAAC system and return the data back to the ISAAC site (hospital) where the data originated. The data will be retained in accordance with the hospital’s records retention policy.

Privacy of ISAAC patient records

In ISAAC, each clinic is identified as either an oncology site or an orthopedics site. An ISAAC administrator can only access data for patients registered under their particular site (e.g., oncology). They do not have access to patient data from another clinic site (e.g., orthopedics) or hospital.