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Patient Experience, GuideHow to Implement PREMs and PROMs in Your Healthcare Centre: A Step-by-Step Guide to Getting Started Today
Five steps, the most common mistakes and a 12-month roadmap for measuring what matters to your patients — and acting on it.
Implementing PREMs and PROMs does not require a complete digital transformation overnight. It requires five steps in the right order: (1) define the objective and the pilot care process; (2) select validated instruments appropriate to the context; (3) choose the administration channel and optimal moment; (4) integrate it into clinical workflows without overloading professionals; and (5) close the loop — from data to improvement actions.
Measuring without acting is the most frequent mistake. PREMs and PROMs are tools for making decisions, not for archiving reports.
Riccardo Begelle, 2026 
15 min 
Before You Start: The Three Mistakes That Doom an Implementation
The accumulated experience of healthcare systems that have been measuring PROMs and PREMs at scale for years — the NHS in the UK, the Scandinavian registries, the ICHOM networks in more than 40 countries, the pilot centres in Brazil, Australia and the United Arab Emirates — reveals a consistent pattern: most implementations that fail do so not because of a lack of technology. They fail because of conceptual errors in the design phase.
Mistake 1: Measuring Without Knowing Why
The first mistake is launching a questionnaire before defining what decision the organisation is going to make with the data. Is the aim to improve a specific process? To compare with other centres? To demonstrate the value of an intervention? To inform patients of their own results? Each objective leads to different instruments, different measurement moments and different data users. Without that defined objective, data accumulates in a repository that nobody consults.
Mistake 2: Starting Too Big
The second mistake is wanting to implement PREMs and PROMs across all services simultaneously. This generates organisational overload, survey fatigue in patients, resistance from professionals and, almost inevitably, partial abandonment at six months. The recommendation from ICHOM, the EIT Health guide for European hospitals and the SECA Guide 2025 all agree: start with a clearly defined pilot care process, obtain quick and visible results, and scale from there.
Mistake 3: Not Closing the Loop
The third mistake — and the most frequent — is measuring without acting. As Chapter 2.9 of the SECA Guide 2025 states: "Measuring more does not mean improving more. Measurement alone does not improve patient experience." Data must be translated into concrete actions that are then re-evaluated. Without that closed loop — measure, analyse, act, measure again — PREMs and PROMs become yet another survey that gets filed away. This is also the central lesson that ICHOM draws from its more than 40 outcome sets implemented in reference hospitals around the world.
""If you don't measure, you can't improve. ICHOM's mission is to enable and facilitate the implementation of Value-Based Healthcare around the world, by defining outcomes that truly matter to patients."
— ICHOM — International Consortium for Health Outcomes Measurement, 2025
— ICHOM — International Consortium for Health Outcomes Measurement, 2025
The 5 Steps to Successfully Implementing PREMs and PROMs
This guide follows the sequence validated by international practice at ICHOM and the lessons gathered in the SECA Guide 2025, adapted to the reality of any healthcare centre, regardless of its size or technological complexity.
Step 1: Define the Objective and Select the Pilot Process
What do I want to achieve? Where do I start?
The starting point is not choosing a questionnaire. It is answering two questions: what decision do I want to be able to make with the data? And in which care process is there the most potential for improvement or the greatest need for evidence?
To choose the pilot process, the following criteria are useful: high demand or high variability in clinical practice, the existence of a motivated clinical team that will lead the implementation, and the availability of validated instruments for that specific process.
A critical step here is forming an interdisciplinary team: a clinical lead, someone from the quality team, a manager and — if possible — a patient representative. Patient involvement from the design stage (not just in validation) is one of the differentiating factors between implementations that succeed and those that are abandoned.
Step 2: Select Validated Instruments Adapted to the Context
PREMs, PROMs, or both? Generic or condition-specific?
Once the objective and the process have been defined, instruments must be chosen. The rule is: do not invent your own questionnaires if validated instruments exist for the same context. The validation process for a PREM or PROM is lengthy, costly and requires methodological capacity that most centres do not have.
For PROMs, the ICHOM outcome sets (more than 40 Standard Sets for specific conditions) are the international standard. They are freely available, mapped to SNOMED and LOINC, and compatible with FHIR/HL7 standards. They cover conditions ranging from hip and knee arthroplasty to colorectal cancer, diabetes, heart failure, mental health and many more.
For hospitalisation PREMs, the Picker Patient Experience Questionnaire (PPE-15 or PPE-33) is the most widely used instrument internationally, with validation in multiple languages. For chronic patients, the IEXPAC and PACIC have specific validation. For primary care, the EUROPEP covers 23 items across four dimensions.
ICHOM recommends a prior GAP analysis: comparing the data the centre already collects with the requirements of the selected Standard Set. Most hospitals collect a large part of the necessary clinical data, just in a different coding.
Step 3: Design the Administration Channel and Timing
When, how and to whom is the questionnaire administered?
The moment of administration is critical for data quality. The general recommendation is to capture experience as close as possible to the care episode — not months later. For PREMs: ideally within 48–72 hours after discharge or consultation. For PROMs: baseline measurements (before the intervention) and follow-up measurements (at 3, 6 and 12 months, depending on the condition) must be considered.
Regarding the channel: the trend is towards omnichannel digital administration — SMS, email, QR, app — which enables scale and automation. However, accessibility must be guaranteed: multiple languages, alternative formats for people with technological limitations or low health literacy. Universal sampling (all patients) is preferable to sample-based sampling.
A key aspect is traceability: is the questionnaire anonymous or identified? PREMs are usually anonymous to reduce social desirability bias. PROMs, being linked to individual clinical outcomes, generally require identification to be useful in clinical practice.
Step 4: Integrate into Clinical Workflows and the Information System
How to avoid overload? Where does the data live?
Integration into clinical workflows is the step where most implementations stall. Healthcare professionals already have a high administrative burden. If collecting PREMs and PROMs represents a significant additional effort, adoption will be low and sustainability nil.
The keys to successful integration are: automating questionnaire administration (so it is sent to the patient without the clinician having to remember); displaying data at the point of care in the format the clinician needs to make decisions; and ensuring interoperability with the electronic health record.
ICHOM has mapped its outcome sets to interoperability standards (SNOMED, LOINC, FHIR/HL7) precisely to facilitate this integration. A system such as RateNow enables omnichannel digital collection, real-time analytics and reporting generation for different levels of the organisation — from the clinical team to management — without requiring manual intervention.
Nordic Healthcare Group, ICHOM's implementation partner in the Nordic and Baltic countries, implemented PROMs linked to clinical outcomes and full costs across four hospitals in Estonia for stroke, creating a visual BI dashboard that enabled benchmarking between hospitals and the identification of best practices.
Step 5: Close the Loop — From Data to Improvement Actions
Who does what with the results? How is it audited?
This is the step that differentiates programmes that transform care from those that end up in a drawer. Closing the loop means that data generates decisions, and those decisions are then re-evaluated.
ICHOM describes three levels of analysis: simple indicators for strategic decisions (management), detailed dashboards for prioritising areas of improvement (quality team), and in-depth qualitative analysis for individual experiences (care team). Not all data is for everyone.
A key step is data quality auditing: what percentage of patients complete the questionnaire? Is it completed at the right time? Is the data consistent with the reference? ICHOM recommends evaluating three dimensions: data completeness, validity and transcription accuracy.
And the final step — frequently forgotten — is communicating to patients what changes have been implemented thanks to their participation. This increases the response rate, reinforces trust in the process and transforms measurement into a genuine empowerment tool.
Common Barriers and How to Overcome Them
The SECA Guide 2025 documents seven categories of barriers to implementing PREMs and PROMs. These are the four most frequent and how to address them:
"Clinicians don't see the value"
This is the most cited barrier. The solution is not more theoretical training, but practical demonstration: showing clinicians real cases in which PROM or PREM data led to concrete changes that improved outcomes. The hospitals that have had the most success in adoption are those that identified clinical "champions" — professionals enthusiastic about change — and gave them visibility and their own service-level data. VBHC demonstrates its capacity to reconnect professionals with their vocation of patient service.
"We don't have enough technology"
Implementing PREMs and PROMs does not require complex technological infrastructure to get started. You can begin with paper questionnaires or simple SMS, as long as there is a process for transferring data to a centralised repository. Technology scales with the maturity of the programme. Hospital Moinhos de Vento in Brazil implemented PROMs for nine clinical conditions over seven years starting from limited infrastructure, demonstrating that strategic will precedes technology.
"Patients don't respond"
Response rates are directly related to three factors: brevity of the questionnaire (the best ones have 10–15 items), timing of administration (the closer to the episode, the better) and perceived relevance (if the patient feels their responses matter, they respond). Survey fatigue is real but manageable: avoid duplications, communicate results transparently and make it clear that responses generate changes.
"We don't know what to do with the data"
This problem has a methodological solution: define in advance — before starting to collect — which indicators will be monitored, at what level, how frequently and who is responsible for acting when an indicator deviates from the established threshold. Automated statistical analysis of quantitative data and the use of artificial intelligence for open-ended responses are dramatically reducing the analytical burden.
Success Indicators and 12-Month Roadmap
A successful PREM and PROM implementation has measurable milestones. This is a realistic roadmap for the first year:
Months 1–3: Design and Preparation
✓ Objective defined and pilot process selected
✓ Interdisciplinary team formed (clinical lead, quality, management, patient voice)
✓ Validated instruments selected (ICHOM Standard Set or validated PREM for the process)
✓ GAP analysis completed: what data do we already collect? what is missing?
✓ Administration channel chosen and tested (pilot with 10–20 patients)
✓ Agreement on who accesses what data and how frequently
Months 7–12: Consolidation and Scale-Up
✓ First improvement action implemented and evaluated
✓ Internal benchmarking: comparison between units or periods
✓ Communication to patients of changes implemented thanks to their feedback
✓ Scale-up plan to 1–2 additional processes
✓ Dashboard available for management and quality team
✓ Presentation of results at a clinical session or speciality conference
Ready to Take the First Step?
RateNow facilitates the entire PREM and PROM implementation cycle: questionnaire design, omnichannel digital administration, real-time analytics and dashboard generation for each level of the organisation. Implemented in reference centres across several countries.
→ Contact us and request a free demo at sales@ratenow.cx
References
1. Pérez A, Bezos Daleske C, Begelle R. Herramientas, facilitadores y barreras: PREM. In: Varela Rodríguez C (ed.). Guía para la Implementación de ASBV. Madrid: SECA; 2025. Ch. 2.9:373-397.
2. García Bergón M, Cremades Sendino M, Leal Orozco AM. Gestión de la transformación. In: Guía SECA ASBV. Madrid: SECA; 2025. Ch. 2.1:219-235.
3. ICHOM. About ICHOM Sets of Patient-Centered Outcome Measures [Internet]. Boston: ICHOM; 2025. Available at: https://www.ichom.org/about-ichom-sets/
4. ICHOM. FAQs — Healthcare Standardization & Implementation [Internet]. Boston: ICHOM; 2025. Available at: https://www.ichom.org/faqs/
5. Cossio-Gil Y et al. The roadmap for implementing value-based healthcare in European University Hospitals. Value Health. 2022;25(7):1148-1156.
6. Weldring T, Smith SMS. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights. 2013;6:61-68.
7. Nordic Healthcare Group / ICHOM. Estonian stroke VBHC implementation case study [Internet]. 2023. Available at: https://www.ichom.org/news/implementation-partner-nordic-healthcare-group/
8. EIT Health. Implementing value-based health care in Europe: Handbook for pioneers. 2020.
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