Innovation in Musculoskeletal Health: Digital tools that enable providers and patients to communicate more effectively and improve continuity of care

Thanks for sharing the stories from early in your career including your ground-breaking efforts to advance the repair of meniscus injuries. That was just the start of reinventing musculoskeletal care. Where did your career go from there?

The focus of my clinical career was always on making sure that my patients received the most appropriate care. Very early on I knew that I wanted to operate my own sports medicine practice within a specialty group of Orthopaedic surgeons.?

Surgery was reserved for those that failed conservative management or for the few cases that are clearly indicated for acute operative intervention. Care of my patients was definitely individualized, and anchored in shared decision-making and?best practices in orthopaedics. This was ingrained in me by my mentors in training, Dr. Robert Leach at Boston University and Dr. Hughston at the Hughston Sports Medicine Clinic, both of whom are world renowned orthopaedic surgeons.?

People would come from all over the United States and the world to both of these incredible physicians. Through my training, I saw the impact that appropriate and inappropriate surgeries had on patients. These are centers of excellence that often attract the toughest cases.? Dr. Hughston would preach to me after evaluating a difficult patient, “Boy, there’s nothing that can’t be made worse by surgery, so know when to operate and when not to operate.” That was incredibly important wisdom that grounded my practice of medicine.?

?It might be surprising to some to hear a surgeon say that surgery wasn’t always the right choice. Did that take a lot of effort for you to help educate patients about the different choices that they had available to them?

Yes, a lot of time and effort was spent helping patients make the right choices for themselves. Patients often did not understand their underlying condition and where they were in their treatment pathway or recovery, or honestly, that they even had options in their treatment.?

At some point, I came to realize that the language or words that we (doctors) use to talk to patients and explain their condition and treatment options was way too technical to understand and overwhelmed patients.?

Just in the past 15-20 years, health systems and providers have placed more focus on health literacy. Patients began turning to the internet to collect more information about their health and wellbeing and increasingly self-diagnosing. It was during the emergence of technology and an improved understanding of patient needs and desires that I saw an opportunity to use digital channels to share patient information. It seemed like a better way to moderate the timing and volume of content delivery, so that both patients and caregivers could better understand their health and the health of their loved ones.

And so with patients wanting different ways to collect information about their health and using digital technology, like the internet, to get that information, how did you start to make the transition yourself?

Well, it started by just increasing the presence of my practice on the internet. What we quickly realized however was that the website only addressed certain aspects of the practice and other important information was still in analogue or paper format; things like patient handouts for exercises or home care instructions after surgery. These were some of the same tools that I had used in my fellowship and they hadn’t really progressed in decades and most importantly, they weren’t personalized to the individual patient. Imagine sharing the same paper handout of exercises being performed by a middle aged man with an elderly female patient with severe arthritis in her knee, and a young male athlete that just tore his ACL? In retrospect, I don't think it served to motivate either.??

What we observed and learned from our patients was a significant lack of adherence to the conservative management programs being prescribed. So with the aid of my physician assistant, we began to incorporate other aspects of the practice that could be digitized and as a first step we developed personalized exercise videos for patients in collaboration with the Hughston Clinic.

So your practice now had a presence on the web, and you started to augment the care that you provided with new tools to increase patient education and personalize the experience. How did this lead into developing the first digital musculoskeletal platform, TrainerRx (now RecoveryOne)?

Outside of my clinical practice I was also working with the San Jose Earthquakes in Major League Soccer, the San Francisco Dragons in Major League Lacrosse, USA Rugby and the local college and high school sports teams.?

In-season, I would work alongside the in-house medical team of athletic trainers and physical therapists responsible for keeping these athletes healthy and on the field of play performing at their peak. But in the off-season, these athletes would return home and we would try to coordinate care, or communicate effectively what those athletes needed to do before the next season. This became very challenging, especially in professional sports where on-field time is money. I knew that there had to be a better way to share information and track recovery, while not seeing the athlete in-person.

At the same time, there were these macro shifts happening to orthopaedic care delivery - surgeries moving from predominantly inpatient procedures to being performed as outpatients. Payers were also pushing this transition in an attempt to lower costs and reimbursement while simultaneously improving outcomes. They wanted more accurate information on patient reported outcomes, or PROMs and were now willing to pay for this data. This shift from inpatient to outpatient surgery was creating a gap in the delivery of critical information delivered to patients and their family and ultimately in the continuity of care. In this new scenario, friends and family were now becoming the home care delivery team and they had very few resources to guide them. It was in fact similar to what I was seeing with my athletes, a breakdown in communication and information, essential to quality care.?

So there are these trends happening in the field, and I was trying to adopt them in my practice to the best of my abilities. At the same time my high-volume practice was placing a high toll on my physical health, with a myriad of ski injuries over several decades, and a strong family history of osteoarthritis, resulting in numerous spine and extremity surgeries. Unfortunately, some did not go as well as others, and I was forced to change careers because of my physical limitations. I decided to step away from practice and focus on patient education and advancement of patient enhanced digital tools to support communication and care continuity. It was with these objectives in mind that I founded TrainerRx now called RecoveryOne, with Bruce Morgan, former head Athletic Trainer for the Earthquakes and Brooks Campbell, a physician assistant from my practice.?

I led the fundraising activities, built the executive team and grew the business that laid the first tracks in the digital musculoskeletal space. This software app incorporated secure messaging for communication, reminders to improve engagement in an evidence-based and progressive home exercise program, and home self care content that was delivered in video format for over 200 different orthopedic injuries and procedures. We also included education and links for patients to learn about their injury/surgery and treatment options, standardized outcome data collection templates and a hybrid physical therapy program.?

A true pioneer! Thanks Dr. Oberlander for sharing more of your story. In the final part of our series, we will explore Dr. Oberlander’s transition to his current role as Chief Medical Officer for FIGUR8 and what excites him about the future of musculoskeletal care.