Each Patient Has One TMS Treatment Course At a Time, Which Has One or More Treatment Sessions.
Each TMS Treatment Session Uses One Or More Stimulation Parameters (TMS, iTBS, or cTBS) Using a TMS Machine
| Select TMS Machine and Coil | |
| TMS, iTBS, cTBS | |
| Target (RDLPFC F4, LDLPFC F3, M1L, etc.) | |
| Absolute Intensity | % MT |
| Pulse | Burst Repetition |
| Train Duration | Intertrain Interval |
| Cycle Time | Trains |
| Total Pulses | Operator |
| Other Machine-Specific Parameters | |
A Treatment Course is a foundational unit of BrainCloud. Just like in a real-world outpatient practice, patients are scheduled to receive a certain number of TMS treatments between Date X and Date Y. They receive treatments at a physical office location and each is either fully or partially covered by the patient's insurance or paid by the patient out-of-pocket.
In BrainCloud, Treatment Courses were designed around these realities, and fully allow customers to to create a course of treatment in the context of when the treatment will begin and end, the Clinical Site where treatment will be provided, and how the patient will pay for the TMS services.
Lastly, the number of treatment sessions per treatment course can be changed in the middle of that course for any number of reasons (for example, if an insurer grants approval for additional treatments).
A "Treatment Session" in BrainCloud is exactly like what happens everyday: a patient comes into an outpatient clinic to receive TMS, and that visit is one of the N number of treatments approved by insurance or paid for by the patient personally.
During a Treatment Session, the patient receives TMS from a machine that uses a magnet placed on their head at one or more locations. Your practice may use only one of the major TMS machine brands (MAG & More, Neurostar, Magstim, or MagVenture). It may also use more than one of these machines. BrainCloud supports any combination of these scenarios and tracks a wide variety of magnet location placements.
Additionally, a common request that psychiatrists around the country told the BrainCloud team as we were building this product centered around TMS machine results. Which TMS machine was causing the most benefit for patients? Were there any patterns as to treatment outcomes between certain types of patients? Each treatment session can be organized according to the specific manufacturer and the specific model.
For each TMS treatment session, you can add one or more stimulation parameters. These include a choice of TMS, iTBS, or cTBS, a selection of a particular TMS manufacturer's brand and model, and the settings specific to that machine.
Within a treatment session, TMS coils are used to stimulate different parts of the brain. With support for TMS, iTBS (intermittent burst stimulation), and cTBS (continuous burst stimulation), BrainCloud is specifically built for tracking which input parameters were used within each treatment session.
The date and time of each is recorded, so you know which came first (for example, a TMS physician might want to know if a patient responded better to a right then left placement versus a left then right placement).
A practice may want to lay out treatment parameters for an entire course of TMS treatments, including target(s), type(s) of stimulation, and specific parameters. At the outset of the course, the prescribing clinician would specify how the treatments would be conducted using this tool. Then, when a patient comes for TMS, each treatment should adhere to what the physician had previously specified. To help facilitate this, the individual administrating the treatment for that patient will find that all input fields are automatically pre-populated with what was indicated in the physician's TMS Treatment Course Order. If a transient change needs to be made (e.g., reduce intensity on one day for tolerability), all deviations from what was ordered will be highlighted, and a notes field is available to document why a change was made. If any enduring change needs to be made to TMS Treatment Course Order, the old settings are saved to a record but not applied in the future, and the new settings are then auto-filled in place of the old.
BrainCloud is agnostic to the hardware made by any TMS machine manufacturer. You can use it with any Neurostar, Magstim, MAG & More, Brainsway, or MagVenture device. When you select a particular device, the applicable TMS stimulation parameters for that hardware appear.
By "integrate," we mean that BrainCloud offers an API that can receive secure, encrypted data directly from a TMS machine anywhere in the world. As settings and parameters are inputted by a doctor or technician performing a treatment, they are instantly synced over to BrainCloud. What results is greater efficiency and reduced risk of human error.
Your practice may start with a single TMS system, but by using BrainCloud, we expect you'll be growing to meet the demands of all those patients with treatment resistant depression and other conditions that respond to advanced interventions.
So how does BrainCloud maximize the utility of your treatment statistics so you can get better insights into what works and what doesn't? Each TMS machine offers different settings, and some allow switching out one coil for another compatible coil. When you apply a TMS stimulation parameter in the context of a Treatment Session, you select an existing TMS machine and coil from your current Practice Inventory. This reflects all of the TMS hardware currently used in your practice, including specific makes and models of TMS hardware, coils, and accessories.
By populating TMS Treatment Sessions and Stimulation Parameters with the TMS Hardware currently listed in your Practice Inventory, the selection is quick and avoids having to repeatedly input a TMS machine manufacturer name, model. Furthermore, this approach eliminates the risk that two users might enter something slightly different but mean the same thing. In these ways, BrainCloud applies uniform consistency across your patient treatment records.
In BrainCloud.io, a "TMS Standard Protocol" is a set of saved data that you can apply with a single click to any TMS Stimulation Parameter, thus relieving you of the need to fill in several form fields.
The United States Food and Drug Administration (FDA) has cleared devices for TMS based on standardized treatment protocols. In addition, researchers are innovating with other protocols that have been shown to be safe and efficacious in well-executed clinical studies.
BrainCloud comes pre-loaded with the first FDA-cleared 10 Hz treatment protocol and a more-recently-approved protocol with a shorter treatment time, as well as directions for how to customize protocols for each practice's own preferences.
Inventory Tracking: BrainCloud helps you keep track of each device when it was placed into use, when the last service call was, when the next preventive maintenance visit will take place, and where in your practice it is located (e.g. which treatment room). This includes TMS systems, IV pumps, pulse-oximetry devices, and other monitors or ancillary equipment.
Inventory Service Records: If a piece of equipment fails when you need it for your patients, major problems ensue. You can keep ahead of things by instantly knowing the history of each device and what is needed to keep it running smoothly.
BrainCloud includes a tool that helps you quickly build structured sentences generated from the data associated with each TMS Treatment Session. These are combined into a single, downloadable PDF document that a patient's insurance company can use to approve further treatments or to populate a patient's printed treatment record.
Each TMS Treatment Session contains a variety of notes, one or more TMS Stimulation Parameters, and data about when and where it took place. However, it's also important to record what occurs between and after a TMS Treatment Session: if the patient complained of any new mental or physical issues since you last saw them, if they report improvements in mood, sleeping ability, or interest, and whether or not they left a visit in good condition.
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