title: Building an electronic health record integrated quality of life outcomes registry for spine surgery.
abstract: OBJECTIVE
  Demonstrating the value of spine care requires adequate outcomes assessment. Long-term outcomes are best measured as overall improvement in quality of life (QOL) after surgical intervention. Present registries often require parallel data entry, introducing inefficiencies and limiting compliance. The authors detail the methodology of constructing an integrated electronic health record (EHR) system to collect QOL metrics and demonstrate the effect of data collection on routine clinical workflow. A streamlined approach to collecting QOL data can capture patient data without requiring dual data entry and without increasing clinic visit times.
  
  
  METHODS
  Through extensive literature review, a combination of QOL assessments was selected, consisting of the Patient Health Questionnaire-2 and -9, Oswestry Disability Index, Neck Disability Index, and visual analog scale for pain. These metrics were used to provide assessment of QOL following spine surgery and were incorporated into standard clinic workflow by a multidisciplinary team of surgeons, advanced practice providers, and health care information technology specialists. A clinical dashboard tracking more than 25 patient variables was developed. Clinic flow was assessed and opportunities for improvement reviewed. Duration of clinic visits before and after initiation of QOL measure capture was recorded, with assessment of mean clinic visit times for the 12 months before and the 12 months after implementation.
  
  
  RESULTS
  The integrated QOL capture was instituted for 3 spine surgeons in a tertiary care academic center. In the 12-month period prior to initiating collection of QOL data, 806 new patient visits were completed with an average visit time of 127.9 ± 51.5 minutes. In the 12 months after implementation, 1013 new patient visits were recorded, with 791 providing QOL measures with an average visit time of 117.0 ± 45.7 minutes. Initially the primary means of collecting patient outcome data was via paper form, with gradual transition to collection via entry into the electronic medical records system. To improve electronic data capture, paper forms were eliminated and an online portal used as part of the patient rooming process. This improved electronic capture to nearly 98% without decreasing the number of patients enrolled in the process.
  
  
  CONCLUSIONS
  A systematic approach to collecting spine-related QOL data within an EHR system is feasible and offers distinct advantages over registries that require dual data entry. The process of data collection does not impact patients' clinical visit or providers' clinical workflow. This approach is scalable, and may form the foundation for a decentralized outcomes registry network.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: Tej D
authors.initials: TD
authors.lastname: Azad
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: Maziyar
authors.initials: M
authors.lastname: Kalani
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Terrill
authors.initials: T
authors.lastname: Wolf
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Alisa
authors.initials: A
authors.lastname: Kearney
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Yohan
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Flannery
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: David
authors.initials: D
authors.lastname: Chen
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Berroya
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Eisenberg
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: Jon
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Shuer
authors.affiliation: Stanford University Hospitals and Clinics, Stanford, California.
authors.forename: Alison
authors.initials: A
authors.lastname: Kerr
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, and.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D004185:Disability Evaluation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011788:Quality of Life; D012042:Registries; D013122:Spinal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: APP = advanced practice provider; CPT = Current Procedural Terminology; DRG = diagnosis-related group; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EDW = enterprise data warehouse; EHR = electronic health record; ICD-9-CM = Classification of Diseases, Ninth Revision, Clinical Modification; MA = medical assistant; MS-DRG = Medicare Severity-DRG; N2QOD = National Neurosurgery Quality and Outcomes Database; NDI = Neck Disability Index; NSQIP = National Surgical Quality Improvement Program; ODI = Oswestry Disability Index; PHQ = Patient Health Questionnaire; QOL = quality of life; VAS = visual analog scale for pain; outcomes; quality of life measures; registries; spine surgery