Overview of Pain Tracker Progress todate at UW

Overview of Pain. Tracker & Progress to-date at UW Medicine Brian Theodore, Ph. D Mark Sullivan, MD, Ph. D David Tauben, MD

What is Pain. Tracker? 1. The UW Pain. Tracker is a web-based tool to assess and graph core patient-reported outcomes of chronic pain management over time. 2. Its purpose is to provide a brief visual display of the relationship between chronic pain treatments and these outcomes, such as pain, function, mood, sleep, and treatment satisfaction. 3. Computerized Patient Reported Outcomes (c. PRO) platform and web application developed by the UW Center for Informatics Research Group and UW Division of Pain Medicine.

Who is Using Pain. Tracker? Clinical Services Date of Adoption Early-Adopters • UW Neighborhood Clinics July 2011* • UW Tele. Pain July 2012** • Sports Medicine at Husky Stadium April 2014 • Center for Pain Relief July 2014 • HMC Pain Relief Service Q 4 2014 – Q 1 2015 (est. ) Planned Expansions • Bone & Joint Surgery Center/Rheumatology • Neurology & Headache Clinic • Pelvic Pain Clinic • Other internal & external partners (Planned rollout 2015 – 2016) * Not web-based. EPIC Smart. Set and Note Template. ** Started paper-forms, migrated to web-based in Q 4 2013.

Common Core, Multiple Versions Common web application designed to support multiple modalities and uses: 1. UW Pain. Tracker initially supported primary care content and workflow, and also Tele. Pain 2. Content added to support sports medicine and ortho needs and rebranded “UW Action. Tracker” 3. Content added to support chronic pain at CPR

Core Measures 1. Pain location 2. PEG – Pain Intensity, Interference with Enjoyment of Life and Interference with General Activity 3. Pain interference with sleep initiation and maintenance 4. Pain interference with patient-defined “Most Important Activity” 5. PHQ 4 – Mood screener for depression & anxiety 6. Opioid Risk Tool 7. Medication tracking 8. Prescription opioid dose (MED) and utilization 9. Satisfaction with Pain Treatment

Service-Specific Measures Function - Oswestry Disability Index - Other location-specific measures (e. g. , NDI, FADI, Quick. DASH) Alcohol Screener - AUDIT-C Treatment Tracking - PT, Injections, Surgeries, Behavioral Medicine Mood Screeners - PHQ-9 - GAD-7 - PC-PTSD Additional Opioid Use Screener - PODS Sleep Apnea - STOP-BANG Global Quality of Life - PROMIS Global Health Pain. Tracker – Sports Medicine “Action Tracker” Pain. Tracker CPR

User Interface

Clinical Report Pain. Tracker

Clinical Report Pain. Tracker Content in table below graphs: • Days per month excess meds • Important activity selected • Prior treatment history • Item responses to selected questionnaires

Challenges 1. Integration with Epic 2. Labor intensive 3. Completion rates 4. Access to dataset

Workflow Analysis In collaboration with UW Department of Human Centered Design & Engineering

Progress with Integration Epic Scheduling Daily Activity Report Pain Tracker PSS/Outcomes Coordinator Reminder Calls

Progress with Completion Rates 100% 80% 60% 45% 50% 40% 20% 0% Baseline Followup Baseline: 131 patients observed over 7 weeks at CPR Followup: 163 patients observed over 7 weeks at CPR

Progress with Completion Rates 27% Completed at Home (with or w/out assistance) Completed in-Clinic (with or w/out assistance) 73%

Progress with Completion Rates (single clinic champion) 128 patients observed over 8 weeks at CPR

Progress with Data Access 1. Current development of flat file with raw and summary scores (Est. Dec 2014/Jan 2015) 2. On-demand download into Excel file 3. Available on-demand for QI 4. Available for research with IRB approval

Questions?