Electronic Intake Data Capture in Pain Clinic

[drg123]

We still have patinets fill out paper charts, which is time consuming and not useful since it has to get scanned into the EMR, so not searchable. The patient is giving you the HPI basically in writing. This should be going automatically into your note, IMO, without manual input.

Is anyone here doing all electronic data capture on intake and follow up? Are you doing PROs (outcome measures) to see the efficacy of your treatments?

One of the departments here hands every patient an ipad in the waiting room.

I'm wondering whether I could make it a pre-condition of seeing me in clinic to fill this out. It would make my time with the patient in clinic more valuable since I wouldn't have to go through the scripted "so on a scale from 0-10, rate your pain" kind of stuff.

Thoughts?

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[callmeanesthesia]

More importantly, what application/vendor are you using to collect this information, and how much does it cost?

We’ve looked at Phreesia, which will collect the electronic intake info, also electronic check in and appointment reminders. I don’t think it flows into the HPI though, at least not with our EMR. The main problem we have is that it will collect benefits info and verify eligibility, but if there’s a keystroke error it won’t kick it back to the patient to redo - the front desk will have to verify and re-enter the info.

One guy in the group built a Google Forms survey (Business platform so it’s HIPAA-compliant) and would then copy and paste the output into his note. However then the data is all text rather than discrete elements so it’s harder to use for meaningless use criteria.

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I’ve looked at this one but haven’t contacted them yet. Their pricing seems great for what they offer. Also not sure of the degree of interoperability with EMR.

 

[gdub25]

Yes, we do this with eClinical Works and it works nicely. They get an iPad and essentially the HPI is done for us as well as past medical history, family history, social history etc. Medications we have to put in ourselves.

In theory this sounds like a dream I know, but still it only works out about half the time. Most pain patients are older and many simply refuse to work with the iPad and say they can’t figure it out.

 

[PainMD23]

We also ask patients to fill out new patient forms / patient packet before their visit, which I have found to be extremely inefficient. We have clinical assistants who then take the paper packet and input the data into the EHR, after scanning the paper forms into the chart. The redundancy of this process has always annoyed me, and I agree there should be a solution that actually works, where the HPI, past medical history, social history, surgical history etc. gets updated automatically from the patient's direct input.

I have been looking for this Holy Grail for quite some time. We currently use Athena, and I explored Phreesia and some other vendors for this process. We noticed that some orthopedics practices and larger university practices had employed this, seemingly with some success. After a lot of vetting and trialing Phreesia, we signed a contract with them for 12 months. During implementation, I spent 100+ hours writing templates for new patient visits, follow-up visits and procedure visits where the information patients provided would flow directly into the Athena note. Unfortunately, after 12 months, it was a failure. We ended up spending much more on HR costs, and our patient through-put went down. Unfortunately pain patients are fairly old, set in their ways, and their family / friends often won't help them use technology. Despite sending emails, texts prior to visits with links to fill out Phreesia prior to the visit, and giving patients iPads at the visit, there was a less than 50% adoption rate for Phreesia. Our staff had to help patients input the data which slowed everything down. We ended up pulling the plug and going back to paper with Clinical Assistants pulling up the slack.

I'm hopeful for some AI healthcare companies to take up the slack and provide a good solution. I've been exploring a few options for AI assisted intake but it doesn't look great yet. Every time I get excited about some digital documentation / EHR advance that actually improves the Physician experience or patient experience I am disappointed. As we all know, EHR solutions in healthcare have been an absolute failure and are a primary contributor to physician burnout.

Our office is currently vetting new EHR's. Although we like Athena, it is very costly. We are looking at eclinical works, ModMed, advancedMD and a few others.

If any of you have a positive experience to share regarding electronic patient data input, AI or other, which flows into the EHR, I am all ears.

 

[Multimodal]

we use eclinical works with a third party company called DrPlan. they send out emails and texts so patients have to check in to their visits through the system. we just rolled it out 3 weeks ago but it does an amazing job at filling the HPI with relevant info. we do still have to update medications like others mentioned above. I also like how it can send preprocedure videos to patients and it documents that they watched it

 

[Painologist]

we use eclinical works with a third party company called DrPlan. they send out emails and texts so patients have to check in to their visits through the system. we just rolled it out 3 weeks ago but it does an amazing job at filling the HPI with relevant info. we do still have to update medications like others mentioned above. I also like how it can send preprocedure videos to patients and it documents that they watched it

What kind of pre-procedure videos do you have patients watch? Also, does Dr Plan sync with eCW nicely?

 

[drg123]

We also ask patients to fill out new patient forms / patient packet before their visit, which I have found to be extremely inefficient. We have clinical assistants who then take the paper packet and input the data into the EHR, after scanning the paper forms into the chart. The redundancy of this process has always annoyed me, and I agree there should be a solution that actually works, where the HPI, past medical history, social history, surgical history etc. gets updated automatically from the patient's direct input.

I have been looking for this Holy Grail for quite some time. We currently use Athena, and I explored Phreesia and some other vendors for this process. We noticed that some orthopedics practices and larger university practices had employed this, seemingly with some success. After a lot of vetting and trialing Phreesia, we signed a contract with them for 12 months. During implementation, I spent 100+ hours writing templates for new patient visits, follow-up visits and procedure visits where the information patients provided would flow directly into the Athena note. Unfortunately, after 12 months, it was a failure. We ended up spending much more on HR costs, and our patient through-put went down. Unfortunately pain patients are fairly old, set in their ways, and their family / friends often won't help them use technology. Despite sending emails, texts prior to visits with links to fill out Phreesia prior to the visit, and giving patients iPads at the visit, there was a less than 50% adoption rate for Phreesia. Our staff had to help patients input the data which slowed everything down. We ended up pulling the plug and going back to paper with Clinical Assistants pulling up the slack.

I'm hopeful for some AI healthcare companies to take up the slack and provide a good solution. I've been exploring a few options for AI assisted intake but it doesn't look great yet. Every time I get excited about some digital documentation / EHR advance that actually improves the Physician experience or patient experience I am disappointed. As we all know, EHR solutions in healthcare have been an absolute failure and are a primary contributor to physician burnout.

Our office is currently vetting new EHR's. Although we like Athena, it is very costly. We are looking at eclinical works, ModMed, advancedMD and a few others.

If any of you have a positive experience to share regarding electronic patient data input, AI or other, which flows into the EHR, I am all ears.

This is a really excellent answer. Thanks for sharing. It sounds like we have the same vision and you've actually tried to enact it, with thus far, sub-par results. I hope we will one day have the solution we need. Our time as physicians isn't well spent by asking the rote scripted stuff and we can't use valuable clinic time to do the kind of comprehensive data gathering we need. If we can get patients to do that on their own time, our clinical encounters can be much more fruitful I think. Heck, I'd build in time before my day to review the inputs from each patient and actually spend more than 30 sec thinking of their diagnoses because I'll have all the data points beforehand.

As far as tools, this looks interesting.

Patient Intake and Preparation

Orbita Patient Intake and Preparation automates routine workflows, digitizing paper-based intake forms and disjointed portal questionnaires to gather critical data.

orbita.ai

I'm going to find out more. Apparently their system will do email, web or phone. The phone could be useful for seniors who maybe don't feel comfortable doing web or text interfaces, but will give answers via phone.

 

[murphles]

In my previous practice in a large orthopedic practice, we used Phreesia. Some individuals could not do it at home. We had an IPAD at the front desk and we would have a front desk person assist them. Everything was in the chart before we saw them. Then we used an early AI company that would listen to all of our visits. I would dictate to the device a little plan and my physical exam findings and the note would magically appear for singnature. They had a person assigned to you who knew what you wanted. I rarely had to touch a note. I am not finding a product for intake that works with ECW integration.

 

[PMROralBoards]

In my previous practice in a large orthopedic practice, we used Phreesia. Some individuals could not do it at home. We had an IPAD at the front desk and we would have a front desk person assist them. Everything was in the chart before we saw them. Then we used an early AI company that would listen to all of our visits. I would dictate to the device a little plan and my physical exam findings and the note would magically appear for singnature. They had a person assigned to you who knew what you wanted. I rarely had to touch a note. I am not finding a product for intake that works with ECW integration.

Question for those who use AI. Do any of you include your interpretation of past imaging like a lumbar mri from a year ago? I feel that if I didn’t have that in my assessment/plan portion, I wouldn’t remember it the next time I was preparing to see that patient in the future and wouldn’t have an idea for what I want to do based on the patients presentation that day

 

[powermd]

I successfully implemented a Google Forms-based solution for patient intake, which has proven highly effective. A key component of this system is that appointments are not scheduled until the intake form is fully completed. I insist on this. Despite my policy, a small number of patients, particularly elderly individuals and those with an IQ < 70 still need to complete paper forms in the office. The data collected from the forms is (almost) seamlessly integrated with my AI scribing tool, allowing for the creation of comprehensive notes with reduced effort.

A while back I engaged a team of developers to create a document scanner that utilizes Optical Character Recognition (OCR) to read faxes. These documents are then processed through an AI summarizer with customizable prompts. The developers invited me to collaborate on the development of a more fully-featured product, which is currently underway. The envisioned product will function as a centralized hub for data integration, encompassing customizable intake forms (including electronic signatures), documents requiring OCR, structured documents, and data from scribing (integrated). This system will generate enhanced notes for each visit, and over multiple visits, the notes will pick up previously entered data. Both in-house and virtual staff will have access to a dashboard to manage and collect data until sufficient information is available to approve an appointment. I'm thinking about a prior-auth tool as well, or maybe integration with third-party outsourcing solutions.

I am not interested in employing AI chatbots to interview patients, as I believe this approach may be off-putting to people. A huge win woul be integration with the Epic. Currently, some companies are recruiting developers with the aim of extracting data from Epic systems. Given the stringent data security measures of hospitals, I would be surprised if API access would be offered free of charge. Presently, I manually download Epic documents for my patients to test the system and generate exceptionally comprehensive notes just because I can. I did a note on Friday that had a chronology of snippets from 20 neuro visits cataloging every drug they tried and the patient's response.