Patients tell their providers how they are doing
Clinicians at Brigham and Women’s Orthopaedic Center and Brigham and Women’s Comprehensive Spine Center, both located at Brigham and Women’s Faulkner Hospital, have long relied on radiographic outcomes and range of motion outcomes to assess their patient’s progress after an injury or surgery. But now they have a new tool: a simple iPad.
When patients check in at the front desk, they are given an iPad and asked to fill out a simple questionnaire while they wait for their appointment to begin. “It’s a way to have patients involved in their own clinical assessment,” says Dr. Brandon Earp, Chief of Orthopedic Surgery at BWFH. “These are outcomes based on questionnaires that patients fill out. They report how they feel they are doing.”
The smart questionnaires ask appropriate questions based on the body part for which the patient indicates they need to be seen. For example, if a patient says they have a knee problem, the iPad app only asks them knee-specific questions. If the patient says they are experiencing a hand issue and they have numbness and tingling, the iPad app will ask them questions related to the hand and carpal tunnel. “It really tailors to the patient to minimize how many questions they have to answer,” explains Dr. Earp.
For Dr. Earp and her fellow clinicians, the information collected while the patient sits in the waiting room informs their visit when they get to the exam room. “They fill it out prior to entering the exam room. Their answers are then uploaded wirelessly into the Partners eCare system, which allows the clinician to access the information before they enter the exam room,” she says. “We can see how they are doing and it allows us to track trends over time. You can look at their prior scores and compare to how they are doing today.”
In general, patients report the iPads are easy to use. However, there have been some challenges to work through. “We’ve experienced some internet connectivity issues at times and since the questionnaires are currently only available in English, some of our patients struggle,” says Deeanna Haidar, MHA, Director of Brigham and Women’s Orthopaedic Center and Brigham and Women’s Comprehensive Spine Center. There are also some patients who prefer not to complete the questionnaire or find that there are just too many questions.
But Haidar has been working with her staff to streamline the process. “When leadership champions the cause, we find it’s motivating for the staff. In fact, it’s the frontline staff who are interacting with the iPads and the patients, so it’s really important that they understand why patient reported outcomes are important and have the knowledge to troubleshoot issues with the iPads. We’ve been trying to share the collection rate data often to encourage staff and we have tip sheets available should staff run into issues.”
Ultimately, any inconvenience seems to be worth it. “At BWFH we are striving to be a leader in incorporating patient reported outcomes into our practice. It’s tremendously helpful both for research and for clinical practice. For research, it allows us to have excellent data to track over time. Similarly, for clinical care on a daily basis, it’s very helpful for me to be able to look at the patient’s responses and discuss with them how they feel that they are doing,” says Dr. Earp. “Plus, the patients seem to appreciate that we are asking them for their participation in improving outcomes.”