Patient Messaging System

Problem: Objectifying a Subjective Problem (Pain)

• Pain is costly – Lost productivity due to pain in 2010: $297.4

to $335.5 billion1

• Pain is complex – Numerous, overlapping causes (muscles,

joints, discs, nerves, etc)

• Pain is subjective – Limited metrics for treatment outcomes

– Recall bias & placebo effect further complicate outcome metrics

1. Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, 2011. The National Academies Press, Washington DC. (page 260)

Identifying the Cause & Effect

• Due to its subjectivity, Cause & Effect relationships difficult to establish in Pain Management

• Thus, no gold standards exists

– Variable treatment algorithm (chiropractor, PT, surgery, minimially invasive procedures, etc)

– Wide geographic variability

Purpose

• To Improve quality of outcome-measures in a subjective arena – “Did this procedure help”

– “Are we closer to diagnosing the source of pain?”

– “What options exist for the cure?”

• To reduce hindsight bias – Real-time inquiry of outcome vs 3-4 week

follow-up

– Quantifiable metrics

Design

SMS initiation with mobile web link – HIPAA Compliant

• Initiated with text reminders without PHI • Linked to website with post-procedure inquiries &

reminders

– Patient Feedback • Inquire about procedure outcomes • Directed responses in real-time vs query pain

score weeks later in follow-up

– Automated Responses • Decision tree algorithms • Practice-defined questions & response; real-time

customizability

Usability

• Procedure Rule Entry System add-on

• Practice defines templates for

– Questions

– Timing posted

– Responses & algorithm for follow-up questions

Development Stage

• Idea Complete

• Algorithm Complete

• Code Complete 02/09/13

• Integrate w/ Allscripts 02/23/13

• Testing phase 03/01/13

Integration

• Interface with Allscripts

– Customizable within Allscripts Clinical Customization Screen

• Data Domains

– Local Fax Server

– Central Web Domain Server with HTTPS

– Local Allscripts SQL database & TxT-Rx SQL database housed on local server

Video Demonstration

Market Plan

• Geographic prevalence of Allscripts – >200 PRO-EHR sites in local region

• Beta testing – Local geographic market – Small clinic (< 3 physicians, 1-2 specialty) – 10 free beta clients

• Data collection & outcome evaluation on beta – Change in cancellations – Quality of data collected

Market Plan

• Price point: Allscripts Pro – $1500 for license & training (conducted

online) – Maintenance:

• Option 1: Ad-based revenue • Option 2: $200 per physician per year

– Cost of hardware: • With Fujitsu fax server $400 • Without Fujitsu Fax server $4000

• Price point: Allscripts Enterprise – Pending outcome of Beta evaluation

Advantages of System

• Increases patient compliance & participation in care

• Customizable – Practice determines use of data

• Forward to insurance • Internal review of treatment protocols • Research

• High-cost Alternatives: – Human interface (staff calls & record-keeping) – Follow-up visits (recall bias, poor quality data)

• Accommodate changing medical market – Consumer desire for interactivity – Accountable Care Organizations & quality reporting