Singapore General Hospital (SGH) Physiotherapy Department is an early adopter of Patient-Reported Outcome Measures (PROMs) to improve person-centric care; and of RPA to collect PROMs questionnaires. It is now sharing its knowhow with other SingHealth institutions keen to implement the innovation in their own practice.

The Physiotherapy Department is the first in SGH to leverage Robotic Process Automation (RPA) to collect Patient Reported Outcome Measures questionnaires, or PROMs, back in early 2022.

It was also one of the first to start collecting PROMs, in 2022. These standardized questionnaires capture patients’ perspective on their health conditions and impact on their quality of life. Examples include those that ask for their assessment of pain levels, mobility and ability to perform specific tasks.  SGH uses PROMs to personalise physiotherapy treatment plans and monitor patient progress.

Jonathan Lim, Senior Physiotherapist, was the key person who assisted SingHealth Polyclinic (SHP) to use RPA to help with their PROMs collection.

The PROMs survey that patients receive and can complete in their own time on their personal devices

How did the collaboration come about?

The request came in September 2023 from SHP after we presented our work with PROMs using RPA to the rest of SingHealth.

How did you go about helping SHP Physiotherapy with their RPA request?

With the help of the Artificial Intelligence and Automation (AIA) unit, from SGH Department of Future Health System, we helped the SHP Physiotherapy Team identify and obtain the necessary - software, licenses - and training needed. I also met up with the physiotherapy colleague at SHP to understand their IT architecture processes and modified the RPA script to suit their needs. We had several sessions to set up RPA processes for their environment.

I have been working on an RPA guide which detailed all of the above, including considerations for data security, compliance and safety. This guide would help the SHP team to independently customise and manage the solution for their needs in the future.

For patients’ convenience, the PROMs survey is available in multiple languages.

It looked like a lot of work. Did this take up a lot of time, on top of your usual work? 

Haha, yes this took up a fair bit of time on top of my usual work. It helped that I had already started on the guides and other materials as part of my plans for RPA. I just had to hasten the timeline to completion as I wanted to be able to share it with SHP before I went away for a year to do my Master of Science studies (I’m in London now!). As for the rest, I put in quite a bit of extra hours to do the necessary prep work and edits so that we could be effective when I met the SHP team.

 When you started working on PROMs, did you imagine yourself dabbling with automation software like RPA? 

We became efficient with PROMs with RPA! Before that, we had to manually administer, and process PROMs, and it was very challenging given the limited time and resources we had on hand. I must say I was a little intimidated when we first started and I am still learning much about automation, but our work has since established what I believe are solid foundations to build a strong culture of PROMs in my team. I must really thank my mentor and Senior Principal Physiotherapist Dr Philip Cheong, my then HOD Jennifer Liaw and the AIA Team for giving me the opportunities to train and do what I can do now with RPA.

What did you find interesting or fun about this whole experience of learning and sharing? Have you always been the kind of person who would document, write down guides and processes, etc?

Yes, you guessed right! I am the kind of person who really enjoys administrative work like documenting, writing guides and processes. I strongly believe in the importance of building robust, clean, and effective processes that works for the users and not the other way round (less admin not more!).  Beyond that, we need to communicate the whys so everyone can contribute and build on something that they can identify as theirs.

RPA really requires you to break down processes step-by-step, as well as challenge your creativity by thinking of workarounds when errors or bugs arise. Skills that are very much applicable in clinical practice as well; build your knowledge, think outside the box, then translate that into something conceivable for someone who may not have that experience or knowledge. That was something I really enjoyed navigating through together with the SHP team as they learnt about RPA, too.

Tell us more about PROMs – why are they important?

PROMs are important for capturing patients' perspectives on their health status, functional limitations, and treatment outcomes. By integrating PROMs into routine practice, we ensure care is both patient-centred and evidence-based.

Beyond physical function, PROMs offer valuable insights into psychological factors like anxiety or depression that may impact recovery. Research has shown that these factors can negatively impact rehabilitation outcomes.

For healthcare professionals, PROMs provide measurable evidence to inform and refine our clinical practice and services.  

Could you share an example of how PROMs has improved care for a patient?

Using PROMs, I was able to help a patient with chronic back pain improve her self-reported functional scores for “Standing for more than 20 minutes to cook a meal” from 2/10 to 8/10; and “Walking to the supermarket 10 minutes away” from 3/10 to 8/10. These were activities that mattered to her.

Ms N, a 64-year-old retired teacher, has been living with chronic lower back pain for over a decade. She was referred to me following an exacerbation of her back pain and described her pain as a constant dull ache with unpredictable flare-ups, affecting her ability to stand or walk. She has seen multiple healthcare providers and tried physiotherapy in the past with limited success.  

At her first physiotherapy session, Ms N avoided discussing her emotional well-being but was notably anxious about her condition, insisting that she just wanted to ‘fix’ her back. Through the use of various PROMs questionnaires, we ascertained that she had persistent negative thinking and misconceptions about her pain, such as “I wonder whether something serious may happen”, and “I keep thinking about how much it hurts.”

Beyond just giving her exercises, we then addressed her pain beliefs over the next few sessions to help her make sense of the pain and techniques to help her manage her thought patterns. For example, she learnt that pain does not always equate to harm, and breaking the cycle of negative thoughts can help her regain her confidence in movement.

By the 6th session, she improved on all her functional and pain perception scores. Whilst she still had some back pain, she reported that she was able to manage it much better, pacing herself and demonstrating the ability to self-manage with regular exercise and rest. Most importantly, she could make that trip to the market and cook for her loved ones.

Do all SGH physiotherapy patients receive PROMs? 

We send digital PROMs to all patients attending the SGH Outpatient Musculoskeletal and Amputee Clinics, and the Scoliosis Clinic. We also have an additional set of 13 other PROMs that our physiotherapists can use on-demand to track the outcomes they need. They range from joint-specific outcome measures to psychological measures that we use as part of evidence-based rehabilitation.

Most of our patients average 4 to 6 sessions, depending on their condition, with our physiotherapists. They will need to complete PROMs on their first and final sessions with us, although we encourage tracking of PROMs throughout their journey. Patients receive SMS with a link to the online PROMs questionnaire before their appointment with their physiotherapist.

How has using RPA helped?

Our current response rate is about 25%. In 2024, RPA processed 14,125 responses, saving our clinicians 1,883 hours  in administering and processing PROMs. This equates to a productivity gain of about $81,000 . The time and value saved are re-invested into patient-contact time and patient-centric initiatives to enhance care.

RPA also allows for us to gather and evaluate data on PROM practices in our team, allowing for an agile response to needs or ideas to enhance our use of PROMs.

Following such early efforts, SGH has established a multi-disciplinary workgroup to spear-head hospital-wide initiatives to enhance PROMs adoption. SGH is also starting to move beyond RPA to explore the inclusion of Artificial Intelligence to further improve workflow.  The use of these new technology offers opportunities to transform healthcare practices and most importantly, free up healthcare providers’ time to focus on improving care for their patients.

Scan to watch video: Behind every seamless patient journey at SGH, there's RPA working its magic! From collecting patient's health status before their appointments to billing, SGH is revolutionising healthcare, one automation at a time.

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