2. 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)
3. 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
4. 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
5. 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
6. Usability
• Procedure Rule Entry
System add-on
• Practice defines
templates for
– Questions
– Timing posted
– Responses &
algorithm for follow-
up questions
8. 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
10. 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
11. 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
12. 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
