Improving the Patient-Physician Relationship in The Digital Era - Transformation From Subjective Questionnaires Into Objective Real-Time and Patient-Specific Data Reporting Tools

Neurospine Neurospine 2019;16(4):712-714. https://doi.org/10.14245/ns.1938400.200 Letter to the editor Corresponding Author Nicolai Maldaner https://orcid.org/0000-0003-0284-1033 pISSN 2586-6583 eISSN 2586-6591 Improving the Patient-Physician Relationship in the Digital Era Transformation From Subjective Questionnaires Into Objective RealTime and Patient-Specific Data Reporting Tools Nicolai Maldaner1, Atman Desai2, Oliver P. Gautschi3, Luca Regli4, John K. Ratliff2, Jon Park2, Martin N. Stienen2,4 Department of Neurosurgery, Kantonsspital St.Gallen, St. Gallen, Switzerland Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA 3 Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland 4 Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland 1 2 Department of Neurosurgery, Kantonsspital St. Gallen, Rohrschacher Strasse 95, 9001 St. Gallen, Switzerland Tel: +41-71-494-11-11 E-mail: Received: October 23, 2019 Accepted: December 3, 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2019 by the Korean Spinal Neurosurgery Society 712 www.e-neurospine.org To the editor The patient-physician relationship is the foundation of patient care and of paramount importance in order to gather information, establish diagnoses, and create treatment plans. Over the last century, we have seen continuous advances in neurosurgery, while the physician-patient interaction has remained conservatively “untouched.” With upcoming digital technologies, however, the dynamic between patients and physicians might undergo a similarly profound transformation. Traditionally, encounters between patients and physicians are reduced to single events, where a patient’s physical and emotional conditions are reviewed. It is commonly perceived as progressive if standardized electronic health records (EHR) using patient-reported outcome measures (PROMs) are employed outside clinical studies.1 There are important limitations inherent to this practice. First, condensing key symptoms such as pain or disability to a PROM questionnaire does not account for daily or even hourly fluctuations, therefore representing a radical loss in data granularity. Second, filling out questionnaires means a lot of effort to patients who, in turn, are usually unaware of the results. This does not promote compliance in an era of patient-centered healthcare. Fortunately, the ongoing digitalization of the healthcare sector provides us with the fundamental tools to collect and sophistically analyze “digital biomarkers” that can be used to construct longitudinal, accurate and intelligible medical profiles based on objective patient data. Examples for this endeavor include the continuous activity tracking before and after elective spine surgery with a low-cost consumer grade wearable accelerometer, or a spinespecific smartphone application that reports objective functional impairment by repeated GPS-based 6-minute walking tests (6WT) before and after conservative or operative treat- Maldaner N, et al. Improving the patient-physician relationship in the digital era ment for degenerative conditions of the lumbar spine (http:// clinicaltrials.gov: NCT03977961,NCT04062942).2,3 These tools allow our patients to self-determine their functional ability within an environment that matters most to them (e.g., home/work). By collecting relevant self-measured outcome data, patients are empowered to take a greater degree of responsibility as an equal partner in their care.4 The selection of objective outcome measures like daily step counts (accelerometer) or distance walked within a fixed time frame (6WT) are metrics that are relevant and understandable, a clear advantage over a constructed questionnaire score. As some of the tools provide analysis functions and immediate feedback (e.g., color coding, similar to traffic signals), patients are entitled to appreciate changes in their health condition over time, be it positive or negative. To improve the engagement of the patient with his/her physician and with these functional assessments, we must rigorously validate the quality of new objective self-measurements and we must present them in fashion both useful and comprehensible to patients and physicians. Information collected by healthcare professionals (e.g., lab results/physiological parameters) could be send to a patient’s smartphone or tablet to be discussed during ward round or consultation.5 At the same time, we have to improve the way patients can communicate their collected health data (e.g., step count/pain) and integrate it into the EHR to ultimately be relevant for shared decision-making. As a precondition, both patients and physicians need to be confident that the highly sensitive personal data is protected against theft and abuse. In conclusion, modern patients increasingly demand control over their healthcare, disease-management and outcome measures. Involving patients more actively by means of digital technology has the potential to improve both diagnostics and treatment, lower overall health expenditures, and further empower the patient into a true care partnership with his physician. While embracing the potentials of these new technologies, physicians https://doi.org/10.14245/ns.1938400.200 have to communicate their expectations and rationales to successfully shape those new pathways of care. We would like to encourage physicians to appreciate the ongoing digital transformation as a trend that has the potential to ultimately strengthen the patient-physician relationship. Opinion of the Editorial Board Editorial Board of Neurospine agrees to publish opinion from the readers of Neurospine. This piece of opinion expresses the view of its author(s), separate from those of editorial policy of Neurospine. CONFLICT OF INTEREST The authors have nothing to disclose. REFERENCES 1. Azad TD, Kalani M, Wolf T, et al. Building an electronic health record integrated quality of life outcomes registry for spine surgery. J Neurosurg Spine 2016;24:176-85. 2. Stienen MN, Gautschi OP, Staartjes VE, et al. Reliability of the 6-minute walking test smartphone application. J Neurosurg Spine 2019 Sep 13:1-8. [Epub]. https://doi.org/10.3171/ 2019.6.SPINE19559. 3. Maldaner N, Tomkins-Lane C, Desai A, et al. Digital transformation in spine research and outcome assessment. Spine J 2019 Forthcoming. 4. Grob R, Darien G, Meyers D. Why physicians should trust in patients. JAMA 2019;321:1347-8. 5. Gautschi OP, Stienen MN, Hermann C, et al. Web-based audiovisual patient information system--a study of preoperative patient information in a neurosurgical department (...truncated)