Industry needs to think bigger and broader about the delivery of musculoskeletal care, says Dr. Padraic Obma, Co-founder of Strive Orthopedics and Surgeon at Orthopedic & Sports Institute of the Fox Valley in Appleton, Wisconsin. He is one of several of the surgeons who presented at OMTEC 2019 and discussed the role of technology in the future of orthopedic care.
Dr. Obma’s direct impact on this push is through his technology company, Strive Orthopedics, which bills itself as a “full-cycle musculoskeletal digital healthcare platform,” bringing together the connectivity of an app and high-quality remote monitoring sensors. The app gives patients increased access to their providers through messaging and guided, monitored exercises in addition to in-app educational materials. Dr. Obma is also a vocal proponent of robotics who wants technology advancements to include surgeon access to data.
We caught up with Dr. Obma just before his OMTEC keynote panel to ask how Strive is a step toward better overall care delivery and to get a sense of how orthopedic device companies can help surgeons enhance patient outcomes by utilizing data.
Pre-operative: Closing the Communication Gap with Patients
Patient experience is an important axis around which outpatient centers compete and, like many surgeons, Dr. Obma’s entrepreneurial endeavor started by recognizing a need among his patients for more access to their providers. On the Strive platform, daily communication with providers through messaging can reduce unnecessary clinic visits while increasing adherence to the care plan, thereby improving outcomes.
“At the Orthopedic & Sports Institute of the Fox Valley, we’re nine independent orthopedic surgeons, and we have six nurse surgeon partners. We were getting quite a bit of patient feedback on this gap between what we’re saying in clinic and what actually translated pre- and post- operatively. Trying to close this gap is an important goal,” he said.
“Patients want more accessibility between visits. They want to be more educated about their episode of care, which we define as one month before through three months after surgery. But it extends way beyond that. It might be several years before they have any surgical intervention planned, but they want to have more accessibility. In a 10- or 15-minute clinic visit, only so much information is transmitted. And most of that is forgotten, right?
“So, we want to have the ability for patients to access the information we’ve curated, or care plans that we’ve created. It gives them a little bit of an extra sense of security and connectivity, but it doesn’t really impact me as a provider other than making it more likely for patients to want to provide us word of mouth referrals and higher customer service scores.”
Intra-operative: Collecting Data from Robotics
Surgeons using robotics often find it difficult to effectively leverage the data generated by these procedures. Dr. Obma says that he doesn’t have access to some data that he truly needs, and other surgeons have noted that the sheer volume of the available data is difficult to manage without more readily available AI solutions. Stryker’s Mako, for example, accounted for approximately 18,000 total knee replacement procedures in the U.S. for the second quarter of 2019. That speaks to a massive trove of information that could potentially be better used for improving patient outcomes.
“I’m a Stryker Mako surgeon, and we’re generating so much data intraoperatively. Pairing that with pre- and post-operative data is becoming more and more important. I think we all see the data trends powering the next wave of orthopedic progress. As long as you don’t ask a provider to do more than they’re already doing, and you make a seamless platform where patients are creating data and we can pair that with our intraoperative findings to create a better overall platform. It is a win/win when the patients are engaged, and the providers aren’t being burdened by additional workload. Robotics are certainly moving us to more and more data. It has to push us in a better direction,” he said.
“On some level, we’re nothing without our data, but right now we’re in this data accumulation mode but we’re not generally able to act on it efficiently yet. The pre-operative data that we generate with patients, we will use it more for engagement. If patients aren’t hitting certain daily tasks, we will delay or reschedule their surgery. We know it’s important for people to be engaged.
“Now, intraoperatively, I’m generating a ton of data. I only get a small sliver of that data. I think the industry should make all of the data available as part of the medical record, rather than trying to protect it. It will help me as a surgeon. If I notice between my trials and final implant that the measurements are off a little bit, I want all of the interval data to know where that happened. Where did my flexion gaps get messed up? I don’t have that information yet.
“Once we move beyond the data collection mode, we see where slight intraoperative tweaks have a positive or negative impact at six months, a year or two years from now. That’s where the magic will happen. We take everything we can generate pre-operatively for the first six to eight weeks, or if we can access patients earlier than that, at least the three-month global period. And we pair that with our intraoperative data to try to make adjustments. But it is still in the early stages. The power of that will bear fruit in the next two to five years, I think.”
Post-operative: Impacting Compliance with Wearables
As we mentioned in our OMTEC Surgeon Pod recap, consumer wearables are generally not ready to be a transformative force in orthopedics. However, Strive has deployed their wearables in a way that can provide cost savings by reducing clinic visits through remote monitoring and patient communication. Initial data provided by Strive estimates cost savings between $1,000 and $3,000 per patient.
“We have massive engagement. Since we launched full-go in October 2018, we’ve had nearly 100% compliance. We feel strongly enough about it in our group that we tether compliance to the scheduling of the surgery. We need to see a certain number of engaged days and certain exercises done so we can assure a better result. We get a lot of patients who, after the three-month episode of care is over, want to continue along the platform. We all know the feeling of being connected to your activity tracker; we like that feedback. It’s gratifying to hit that 10,000-step goal or complete your three sets of ten. We’ve generally had really positive feedback on that. And it tends to be our older patients who are the most engaged, messaging back and forth, completing their tasks and education,” Dr. Obma said.
“Our ultimate goal is to help improve the delivery of musculoskeletal care from the initial injury through as far post-operatively as we can, which may span several years. Trying to improve that workflow to take the burden off the provider and empower the patients, while improving outcomes at a lower cost. We all focus on the episode of care, and rightfully so, but it’s much bigger and broader than that. That’s our focus long-term, changing the workflow of delivering musculoskeletal care.”
Improving Patient-Care Workflow means a Long Road Ahead
Technologies like robotics, augmented reality, artificial intelligence and wearables have incrementally improved surgical workflows and outcomes. However, they are generally early-generation technologies that often disrupt the surgeon’s procedural flow and do not yet work together in a seamless manner that unburdens the provider. As Dr. Obma told us, these technologies will begin to show their true potential in three to five years. For the interim, solutions like Strive Orthopedics get us another step closer to delivering care in the most efficient and effective way possible.