Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: ABJS Carl T. Brighton Workshop on Health Informatics 16 articles


Electronic Data Capture for Registries and Clinical Trials in Orthopaedic Surgery: Open Source versus Commercial Systems

Jatin Shah BAMS, PDCR, Dimple Rajgor MSc, Shreyasee Pradhan MSc, Mariana McCready BS, Amrapali Zaveri MSc, Ricardo Pietrobon MD, PhD, MBA

Collection and analysis of clinical data can help orthopaedic surgeons to practice evidence based medicine. Spreadsheets and offline relational databases are prevalent, but not flexible, secure, workflow friendly and do not support the generation of standardized and interoperable data. Additionally these data collection applications usually do not follow a structured and planned approach which may result in failure to achieve the intended goal.

Ethical Choice in the Medical Applications of Information Theory

Scott V. Haig MD

Alongside advances in medical information technology (IT), there is mounting physician and patient dissatisfaction with present-day clinical practice. The effect of introducing increasingly complex medical IT on the ethical dimension of the clinical physician’s primary task (identified as direct patient care) can be scrutinized through analysis of the EMR software platform.

Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology

Elizabeth W. Paxton MA, Maria C. S. Inacio MS, Monti Khatod MD, Eric J. Yue MD, Robert S. Namba MD

A Total Joint Replacement Registry was developed in a large community-based practice to track implant utilization, monitor revisions and complications, identify patients during recalls and advisories, and provide feedback on clinical practices.

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

John F. Clough MD, DPhil, Lewis G. Zirkle MD, Robert J. Schmitt

The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries.

The Internet and the Physician-Patient Relationship

Randale C. Sechrest MD

Since the emergence of the public Internet in the early 1990s, the healthcare industry has been struggling to understand how best to utilize this resource. During the last decade there has been an increase in both the interest and participation by healthcare providers in the Internet space, but many observers continue to push for more development of healthcare resources to better support the provider-patient relationship.

Virtual Reality in Orthopaedics: Is It a Reality?

Jay D. Mabrey MD, Karl D. Reinig PhD, W. Dilworth Cannon MD

Virtual reality (VR) simulation has been a requirement for airline and military pilots for decades and is only now being integrated into surgical training programs. Thus far, orthopaedic training programs have been slow to adopt VR training.

Private Practice Outcomes: Validated Outcomes Data Collection in Private Practice

Jack Goldstein MD

Improved patient care is related to validated outcome measures requiring the collection of three distinct data types: (1) demographics; (2) patient outcome measures; and (3) physician treatment. Previous impediments to widespread data collection have been: cost, office disruption, personnel requirements, physician motivation, data integration, and security. There are currently few means to collect data to be used for collaborative analysis.

Orthopaedic Literature and MeSH

Stuart J. Nelson MD, FACMI, Jacque-Lynne Schulman MA, MLS

Since 1916 there has been a recognized demand for a method of classification of orthopaedic literature inclusive enough to permit the proper collection and retrieval of all literature on the subject. Today, MEDLINE, available through the PubMed interface, has become the de facto standard for organization and retrieval of medical literature. The Medical Subject Headings (MeSH), used to provide indexing and assist in searching, are partly responsible for this standard. Understanding how MeSH is built and maintained may lead the user to a better understanding of how to use MEDLINE, and what to expect from the indexing of an article.

Computational Ontologies in Orthopaedic Surgery

Ricardo Pietrobon MD, PhD, MBA, Amrapali Zaveri MSc, Luciana Cofiel PT, PhD, Jacson Barros MSc, Jatin Shah BAMS, PDCR

Information Technology (IT) plays an important role in storing and collating the vast amounts of healthcare data. However, analyzing and integrating this data to extract useful information is difficult due to the heterogeneous, siloed, disparate, and unstructured nature of the data.

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Shepard R. Hurwitz MD, David C. Slawson MD

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid.

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

Sameer Badarudeen MD, Sanjeev Sabharwal MD

Health literacy is the single best predictor of an individual’s health status. It is important to customize health-related education material to the individual patient’s level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material.

Utilizing Information Technology to Mitigate the Handoff Risks Caused by Resident Work Hour Restrictions

Joseph Bernstein MD, Duncan C. MacCourt JD, MD, Dan M. Jacob BA, Samir Mehta MD

Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called “handoff”) at the end of shifts.

The Potential Research Impact of Patient Reported Outcomes on Osteogenesis Imperfecta

Catherine A. Brownstein MPH, PhD, Paul Wicks PhD

Osteogenesis imperfecta (OI) is an inherited connective tissue disorder with many phenotypic presentations ranging from mild to severe. It is often called “brittle bone disease.” Treatment consists of physical therapy, surgical interventions, medications and, in some cases, experimental therapies. Because treatment is not standardized and is often experimental, information on the success of different methods is usually not available or well documented.

Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities

Kathryn Doughty MD, MPH, MS, Linda Rothman BscOT, MHSc, Luke Johnston BSc Student, Kim Le MPH, Joanna Wu BSc, Andrew Howard MD, MSc, FRCSC

The Internet should, in theory, facilitate access to peer-reviewed scientific articles for orthopaedic surgeons in low-income countries (LIC). However, there are major barriers to access, and most full-text journal articles are available only on a subscription basis, which many in LIC cannot afford. Various models exist to remove such barriers. We set out to examine the potential, and reality, of journal article access for surgeons in LIC by studying readership patterns and journal access through a number of Internet-based initiatives, including an open access journal (“PLoS Medicine”), and programs from the University of Toronto (The Ptolemy Project) and World Health Organization (WHO) (Health InterNetwork Access to Research Initiative [HINARI]).

Improving Web Site Performance Using Commercially Available Analytical Tools

James A. Ogle MSc, MBA

It is easy to accurately measure web site usage and to quantify key parameters such as page views, site visits, and more complex variables using commercially available tools that analyze web site log files and search engine use. This information can be used strategically to guide the design or redesign of a web site (templates, look-and-feel, and navigation infrastructure) to improve overall usability. The data can also be used tactically to assess the popularity and use of new pages and modules that are added and to rectify problems that surface.