520 - Transitioning from a Paper-based to a Web-based Data Collection System...

#520 Transitioning from a Paper-based to a Web-based Data Collection System in a Community-based Orthopedic Surgery Practice

Economics/Cost Effectiveness

Poster Presented by: F.W. Schranck


F.W. Schranck (1)
S.C. Erker (2)
M.D. Britt (1)
C.R. Schranck, III (2)
M.A. Richards (2)
A.D. Desai (1)

(1) SPIRITT Research, Saint Louis, MO, United States
(2) The Spine Research Center, Saint Louis, MO, United States


Introduction: “Critical evaluation of the results of treatment is one of the most important and most effective methods of improving medical care. [1]” Cost and complexity have traditionally limited the pursuit of evidence development and patient-reported outcomes (PRO) research in community-based practices. Evidence collection and reporting are becoming increasingly important—and sometimes mandatory—for healthcare professionals, patients, payers, and innovators. A web-based PRO system may increase the ability to collect medical evidence regarding treatment outcomes and may reduce the resources necessary for delivery and verification of compliance and accuracy. This study details the successful transition from a paper-based to a more efficient and effective web-based system.

Methods: An experienced clinical research team initially established a paper-based data collection infrastructure in the community practice of a board-certified spine surgeon. Standard Operating Procedures (SOPs), in accordance with Good Clinical Practice (GCP) guidelines, were implemented to optimize the data collection process in an effort to develop evidence to improve patient care. High resource utilization with this system included patient phone calls 4x+/year, mailings, clinic supervision of research patients, staff data entry and quality control, source document management, etc. This same team recently established a web-based data collection and storage infrastructure. Similar to their longstanding and successful paper-based system, SOPs/GCP guidelines were implemented. Validated PRO are now collected electronically on all surgery patients at established time points: prior to or in lieu of their visits via electronic patient portal, or in the office, using an iPad. Email links are automatically sent to patients when they are due to have data collected. The research staff can monitor completion of patient forms online, in real time. To achieve a high-rate of compliance, they make courtesy phone calls to explain the importance of completing the online questionnaires and to thank patients for their participation. Phone calls add a personal element to a request for data and provide an opportunity to verify patient contact information.

Results: The database includes nearly 5000 surgery patients (3669 lumbar/1242 cervical) since 2001. The analysis of this data has contributed to improvements in the quality of medical care by detailing PRO in 46 peer-reviewed journal publications, 115 abstracts, and 44 scientific exhibits/posters. After implementation of the web-based data collection system, over 95% of patients preferred web-based data collection over paper-based questionnaires. A 50% reduction in resource utilization is projected with the new system.

Discussion: A patient portal streamlines data collection for both patients and coordinators. Real-time data capture reduces labor by eliminating manual data entry and introducing built-in quality control measures. SOPs to collect and report patient data and PRO serve as a useful foundation in the current transition to lower cost and more accurate web-based data collection. Participation of other community practices should also increase dramatically with web-based methods.


[1] Swintkowski MF, Buckwalter JA, Keller RB, Haralson R. The Outcomes Movement in Orthopaedic Surgery: Where We Are and Where We Should Go. J Bone and Joint Surg Am., 1999 May; 81(5): 732-40.