Scaling Remote Implementation of IVI-CAT at SNEC: A Hybrid Model for Routine QoL Collection (2024–2025)​

Collecting quality-of-life (QoL) information for patients undergoing treatment is widely recognised as important but remains challenging to roll out at scale due to technical and operational barriers. Patient uptake is often low when questionnaires are long, repetitive, and disconnected from routine clinical workflows.

PROMinsight’s Impact of Vision Impairment Computer Adaptive Test (IVI-CAT) was designed to address these limitations by delivering a time-efficient, patient-relevant assessment that integrates seamlessly into clinical systems.

Over a 12-month implementation study conducted between 2024 and 2025 at the Singapore National Eye Centre (SNEC), we evaluated the feasibility and uptake of IVI-CAT in patients undergoing treatment for diabetic macular edema, glaucoma, and cataract.

The IVI-CAT was delivered pre-appointment via an automated secure weblink sent through WhatsApp, allowing patients to complete the assessment remotely before attending their clinic visit. This workflow was enabled in collaboration with our Patient Engagement Partner, BotMD.

Non-completion of remote IVI-CAT links was monitored through a central dashboard. Patients who had not completed the assessment remotely were offered an additional opportunity to complete IVI-CAT via tablets in clinic immediately prior to their appointment. All IVI-CAT scores were integrated into patients’ electronic medical records (EMR) for same-day review by the treating clinician.

Over 700 patients completed IVI-CAT during the 12-month period. Outcomes exceeded expectations, with a high uptake rate of greater than 80% achieved through the hybrid model of remote and in-clinic completion.

Patients reported a positive experience using IVI-CAT:

“The questions were quite nice because people rarely ask you about these kind of things. So, having a questionnaire that asks these questions helped me feel a bit more seen.” (SNEC_CAT_021, glaucoma clinic patient)

“I just used my mobile phone to complete it. It was very convenient.” (SNEC_CAT_029, glaucoma clinic patient)

“Very easy. It only took a couple of minutes.” (SNEC_CAT_010, glaucoma clinic patient)

Clinicians also found value in having IVI-CAT scores available within SNEC’s EMR to guide clinical management:

“One patient had good vision but poor QoL scores. Without CAT, I’d have assumed everything was fine and moved on.” (Prof Shamira Perera, Senior Glaucoma Consultant)

“Unlike lab numbers that don’t mean much to patients, CAT prompts show what’s worrying them right now. It’s real, contemporary, and changing over time.” (SNEC_CAT_HCP03 clinician)

“… the main thing for the CAT test is it gets the patients to, just more systematically respond to the questions … gives us a metric … to quantify what our subjective performance is in the clinic. So that’s very helpful to have because especially if there’s a mismatch between what we see structurally and what patients tell us.” (SNEC_CAT_HCP02 clinician)

“… happier patient means a happier service, means more patient satisfaction, means more patients. So, of course, for business wise, that’s also good for SNEC. PROMs also guide quality improvements like waiting times.” (SNEC_CAT_HCP01 clinician)

This study demonstrates that a hybrid delivery model combining automated remote distribution with structured in-clinic follow-up can overcome common implementation barriers and support sustainable QoL data collection at scale. The integration of IVI-CAT into SNEC’s EMR enables clinicians to incorporate patient-reported outcomes into routine decision-making, strengthening alignment with value-based healthcare principles.