The Genesis of… By Fred Eberlein

ReliefApproximately 90% of us will experience acute or chronic pain at sometime in our lives.  Given this fact it’s fair to say that pain is a normal part of living.

Yet because pain affects each of us differently and has strong psychological undercurrents, it must be assessed and treated on a case-by-case basis. Research has shown that untreated or under-treated pain can have devastating consequences, both for the patient and the healthcare system.

We have built ReliefInsite to serve as a secure and HIPAA-compliant meeting place for patients with pain and
those caring for them.  Central to our philosophy, and technology, is the concept of real-time, shared access of structured information derived from patient input that enables doctors, nurses, therapists
and others to better assess and treat patients with any pain condition.

Because the spectrum of pain is diverse and calls for differing therapies, we have architected ReliefInsite
to be highly customizable and built it entirely on open source technology. Not only can different data be collected depending on the condition, but the tone and objectives of the diary can change too.  A good
example of this is in Workers’ Comp where it is important to emphasize progress toward back-to-work goals, such as activity levels and range-of-motion (of the injured body part), rather than focusing on the location and intensity of pain as is done in most diaries.

The core of our service is a patient diary/journal where clinically significant details specific to the diagnosis and ongoing treatment of pain are recorded – by the patient, case nurse or others involved in the patient’s care.  Organizing and presenting such information in a clear and easy-to-interpret way –
predominantly in graphs and charts – enables clinicians to cut through the fuzziness of pain and to better treat patients.  It also provides many patients with a sense of control over their pain, often because
they can better explain and quantify it to others.

Since launching ReliefInsite in May 2006 I have been surprised by the number of patients who have reported the added sense of control they feel in keeping a diary.  Conversely, and contrary to the concerns of a minority of clinicians, only one user (of about 5,000 to date) has reported increased sensitivity to pain since using the diary.

Considering that a patient’s usual meeting time with most physicians is less than 20 minutes and that,
on average, (at least according to one study) patients are afforded about 18 seconds to answer the question of how they’re feeling,  the need for improved patient control and communication is greater now than
ever.  Nowhere is this more evident than in the area of pain management.

Today, ReliefInsite offers a Free Diary service for patients and a Free Healthcare Provider portal for the medical community. Patients can invite their healthcare providers to view their diary reports, and conversely healthcare providers can invite their patients to use the diary.  In either scenario both are connected
via our Sharing Partner scheme that enables secure and real-time access to diary reports.

It’s a good start, but much work lies ahead before ReliefInsite becomes the must-have service for patients,
clinicians and the healthcare community at large.

In addition to continual refinements to our existing service, our near-term objective is to create an un-tethered platform for reaching out to patients to collect their readings over land and mobile phone connections, without the need for Internet access.  Compliance, whether for taking medications or reporting pain symptoms, remains one of the biggest hurdles facing healthcare.  Pro-actively
collecting such details is the answer, albeit maybe not the ultimate solution.

Beyond this we will begin to incorporate protocols into our service.  This, I think, is very exciting and will serve to guide both the patient and his or her doctor along the most effective known paths for the diagnosis and treatment of pain.

Considering that the majority of physicians have no training in pain management, we hope this approach will evolve ReliefInsite from a nice-to-have to a must-have.

Ancient History…

The idea for ReliefInsite came to me during a weekend meeting I had with a reproductive endocrinologist,
Mark Perloe MD, in Atlanta.  It was June 2000.  Earlier that year I had invested in a small startup named Ovusoft, based in Virginia. We were developing an application for helping women to track their menstrual cycles in order to determine when they are most likely to conceive.

I would never have come across Ovusoft had my wife and I not experienced such troubles of our own, as happens to many couples who start families later in life, as we did.

It was my first meeting with Mark and I was interested in getting his feedback on the application we were
developing.  At one point in the several hours of meetings we had, Mark touched on the point of pelvic pain and wondering if this was a feature we should add.

As Ovusoft was about helping women to conceive and not about pain, we scrapped the idea.  But the notion was an interesting one to me and got me thinking about available applications
for helping patients with pain.

During the weeks and months that followed I began to research the “pain” market.  As is often the case when folks with IT backgrounds step into healthcare, I was astonished to learn that despite tens, and perhaps hundreds, of different pain assessment forms in use, none had been put into an interactive digital
form – beyond creating HTML and PDF downloadable versions.

The American Pain Society (APS) had recently coined pain the “fifth vital sign” to draw attention to the need
for better pain management programs.  And JCAHO (the Joint Commission on the Accreditation of Healthcare Organizations), who accredit about 60% of all healthcare organizations in the US, had issued its Patient Bill of Rights in order to require patients to report pain and
healthcare providers to ask about it.

The overall concept was quite simple: provide patients with a digital Body Map where they can point to identify the location of their pain, and combine this with a scale to show intensity.  This, along with a series of questions and descriptive terms, was the essence of all the pain assessment forms I had found.

Fearful that such a simple notion could be taken up by an individual or organization with deeper pockets than mine, I decided to file a patent. In September 2000, with the help of law firm Banner & Witcoff, I filed my first patent.  This was to be followed by another patent about a year later. Both were
eventually approved.

Although we are still in startup mode, ReliefInsite has evolved considerably from those early days of PowerPoint slides and Flash demos to a robust services platform that includes versions
for Patients, Providers and Case Nurses.

With Web 2.0 and social networking clearly in our midst, we look forward to a network that not only connects but interprets and acts upon patient needs.  This is the future that we envision and hope to play a part in shaping.

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