Massage & Informatics

By Virginia Cowen, LMT, PhD
January 3, 2018

Massage & Informatics

By Virginia Cowen, LMT, PhD
January 3, 2018

Massage therapists have data. How well are we using it? As a client-centered profession, our focus is on individualized treatment. Our health history forms help us learn about our clients, our session notes summarize what we do and how it affects each client.

On a one-on-one basis, the way we document our sessions helps us to build relationships with clients. However, this information also serves a potentially higher purpose. Aggregating it for analysis could provide great insights into your practice, the profession, and effects of massage on health and well-being.

Understanding Informatics

Health informatics is an interdisciplinary field that uses information technology to collect, organize, store, and retrieve health/medical data. Migration in healthcare from paper and pencil medical records to electronic health records (EHRs) has increased the ability to access medical data to connect healthcare providers with each other and to take a macro view of patient health outcomes.

For example, gender differences in diagnosis and treatment for pain were revealed in a sample of 17,583 veterans.1 Differences in healthcare utilization were noted in a sample of 747 patients with low back pain depending upon where they entered the healthcare system.2 The data analyzed in these studies were collected for clinical purposes — not just for research.

The results of these analyses provide great insight into care for patients. The term "meaningful use" describes the use of EHR information in a way that respects patient privacy to improve quality of care, coordinate care delivery, and engage patients to improve health outcomes. In other words, EHR data should be collected and used for healthcare and not just for research purposes. The EHR serves a key role in patient care and in analysis.

Wellness & Technology

The wellness industry — including massage, fitness, spas, and other services — lags behind medicine in use of EHRs for several reasons. EHR technology is expensive. Paper and pencil is cheap; it is also user-friendly for hands covered in oil or lotion. While the health care industry is under pressure to reduce healthcare costs3 (particularly costs associated with chronic diseases) the wellness industry is different.

Wellness services are largely paid out-of-pocket, so we are not subject to the same pressure. We know that our clients feel better and rely on that feeling to keep them coming back. Information technology (IT) growth and innovation in the wellness industry has focused on practice administration: scheduling and billing. The wellness industry is devoted to health--not crunching numbers. But analyzing practice records to identify if, when, and why clients re-book massage. This can help with practice management and that is a starting point.

There is much more potential for massage therapy practice data. Coordination and collection of data for analysis creates the potential to answer important questions about massage that could not be captured in small research studies. For example, comparing differences in outcomes based upon treatment design is important for us to recognize. This is a something that could be explored on a small scale with an expensive pilot study. On a larger scale we already have the data.

Health History

Massage-related data is similar to — but different from — other health data. Each massage has a beginning, middle, and end that links the health history and massage treatment design with client outcomes. Health history data the only part of this cycle that is similar in structure to conventional healthcare EHRs. Data documenting massage treatment design is different from EHR data because treatments are individualized and generally written as a narrative.

Client outcomes are important data that should be documented. Some direct outcomes (e.g. joint range of motion) are easy to assess and document. Other direct outcomes (e.g. relaxation, pain, stress) are subjective making them challenging to assess and document. Indirect outcomes of massage (generally feeling better, experiencing less discomfort, managing stress, etc.) are very important. This is what keeps clients returning for massage and helps them figure out when to schedule massages.

Analyzing the Data

There is a level of discomfort in analyzing what we do as massage the-rapists. What if the data do not reveal what we believe to be true? It will. Look at the "discussion" section of massage research articles and you will see language that attributes lack of significant results due to the small sample sizes, short duration of the study, and length of follow up.

Massage practice does not have those problems. The work we do for our clients is important. They keep coming back. Welcoming informatics into massage can help support the "why" and "how."

References

  1. Weimer MB, Macey TA, Nicolaidis C, Dobscha SK, Duckart JP, et al. "Sex Differences in the Medical Care of VA Patients with Chronic Non-Cancer Pain." Pain Medicine, Dec 2013; 14(12):1839-47.
  2. Fritz JM, Kim J, et al. "Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs." Journal of evaluation in clinical practice, Apr 2016; 22(2):247-52.
  3. Burmaoglu S, Kıdak LB, Berber C, et al. Evolution of connected health: a network perspective. Scientometrics, 2017; 6(15):1-20.