Archive | January 2014

Mobile Medical Apps and the Orthopaedic Surgeon

Results from a new JBJS study, Mobile Technology/Social Media Usage Among Orthopaedic Surgeons, show orthopaedic surgeons are frequent users of mobile medical apps, with seven in ten orthopaedic surgeons having downloaded at least one app on their smartphone. Roughly 40% of 320 respondents to a JBJS email survey say they are using medical apps more than they did a year ago, and 41% of the respondents say they have downloaded an app offered by a supplier.  The types of information surgeons most desire in an app include drug information, surgical techniques, journal articles, and patient information. The favorite medical app mentioned was Epocrates, an athenahealth app that provides point-of-care medical information to doctors. Other favorite apps include AO Surgery Reference an d Medscape.

The findings also show that orthopaedic surgeons are getting more comfortable using mobile devices for orthopaedic tasks such as referencing drug data, checking formulary schedules, reading journals, communicating with their patients, and seeking information about orthopaedic devices/products. (see charts).  Finally, the findings reveal that although many surgeons are not using LinkedIn and Facebook, one in five believe that social media will have a positive impact on orthopaedic care in the future.

New JBJS survey shows that orthopaedic surgeons use medical apps frequently and that they’re getting more comfortable using mobile devices for communicating with patients.

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Mobile Medical Apps and the Orthopaedic Surgeon image 2

5 Tips to Transition from Stage 1 Meaningful Use to Stage 2

The Centers for Medicare and Medicaid Services has proposed extending the attestation period for Stage 2 of Meaningful Use of electronic health records (EHR) through 2016. The extension would give providers more time to meet the requirements, still be eligible for 2014 incentives, and start thinking about Stage 3 requirements. For providers embarking on the transition from Stage 1 to Stage 2, Michael Nunimow, CEO and cofounder of drchrono, offers five tips.

Physician Quality Reporting System – Bonus Date Fast-Approaching

February 28, 2014 is just around the corner. That’s the last date for physicians to submit 2013 clinical performance data as part of the Physician Quality Reporting System (PQRS) and get a 0.5% bonus for doing so.  For those who use a patient registry to submit their data, the deadline is the end of March 2014. For instructions on how to get started with the PQRS, click here.

Publisher’s Note: Filtering for the Highest Quality

Information is easier to get but seemingly less reliable every day. That’s why quality filters like JBJS are so important. And why we spend so much time and effort deciding what not to publish.

This is one of the great hidden aspects of a strong journal – the material that is deemed unsuitable to publish. These decisions can occur for any number of reasons, but usually these boil down to quality, novelty, or interest.

Quality refers to the kind of study, its power, the strength of its hypothesis and analysis, and the care the authors take to draw conclusions from the data. An underpowered study, a muddy analysis, or extravagant conclusions can independently or in combination scuttle a paper’s chances.

A paper that has novelty breaks new ground. It can be a surprising hypothesis borne out by evidence, a new method for divining previously undetected perspectives on an old problem, or simply a new discovery.

Relevance is another word for interest, and making sure the papers we publish are relevant to the high-powered orthopaedic professionals we reach is a key function of our review process.

Together, filtering for these and other aspects of quality research, from IRB approval to author conflicts to plagiarism, all takes a good deal of expertise and effort. But it’s effort that most readers never see. It is what we publishers call “the cost of rejection,” and it can be a significant expense, especially for highly selective journals.

Last year, we implemented a submission fee to help defray some of the costs of rejection. Since then, we’ve seen our rate of submission decline to about the same level we had in 2010, while the level of evidence of the population of papers has increased. We are getting fewer, better papers. And we’re able to take more care with each one. Overall, while we know this was an unexpected fee for our authors, we feel the benefits have been mutual.

In an age of quantity – more information, more emails, more blog posts, more tweets, more statuses – we continue to believe that quality is a key differentiator. Our commitment is deep and lasting in this area. We hope our efforts are apparent in what we deliver.

Q & A with Dr. Ran Schwarzkopf and His Experience Using Google Glass

After reading our item about Google Glass in the January OrthoBuzz, Dr. Ran Schwarzkopf, assistant clinical professor of orthopaedics at the University of California, Irvine (UCI), wrote us to explain briefly how teams of surgeons, nurses, and anesthesiologists use the technology at UCI. Dr. Schwarzkopf kindly responded to our follow-up questions in the following interview.

JBJS: Thank you, Dr. Schwarzkopf, for sharing your experiences with OrthoBuzz.  First, can you tell us a bit about yourself?

Dr. Ran Schwarzkopf: I am an assistant professor in the Department of Orthopaedic Surgery at UCI, where I head the Adult Reconstruction Joint Replacement Service. I trained at NYU Hospital for Joint Diseases and completed a fellowship in adult reconstruction at Brigham and Women’s Hospital in Boston. I am part of the UCI Joint Replacement Surgical Home, which is a perioperative clinical care model jointly run by orthopaedics and anesthesiology.

JBJS: We understand that you’ve been using Google Glass in some interesting ways.  How did the program get started?

Dr. Schwarzkopf: UCI has always been a pioneer in incorporating new technology into medical care. We have a long tradition of innovation and entrepreneurship. Due to the orthopaedic department’s close relationship with our anesthesia department and our successful Joint Replacement Surgical Home, we were approached by Pristine, a company that develops platforms for integrated medical systems. Together we decided to explore the use of different interactive glasses for operative applications. We started working with Google Glass as our first glass prototype, but we have also examined similar products from other companies. Together with the developers at Pristine, we designed different clinical pathways for optimizing the use of the Glass to enhance our clinical work from both the orthopaedic and anesthesiology perspectives.

JBJS: Was there a particular challenge you hoped Google Glass would help you address?

Dr. Schwarzkopf: In today’s orthopaedic operative environment, efficiency, cost reduction, and successful outcomes need to go hand in hand. We were looking to increase team interactivity and real-time communication while decreasing waste and unnecessary traffic in the operating room. We also wanted  to enhance our resident learning options. Our anesthesia colleagues were looking to improve communication between their team members with real-time visuals.

JBJS: Please describe some of the things you and your colleagues have done using Google Glass?

Dr. Schwarzkopf:  The orthopaedic team was able to broadcast surgery live to team members who were not inside the operating room, giving residents and visitors the ability to observe the procedure from the “surgeon’s point of view” without increasing traffic in the operating room. The surgeon was also able to view both check-lists and images on his glass view screen during the procedure. The nursing team inside the OR was able to communicate with our nurse manager without needing to exit the room or use the phone through a tablet screen outside the OR. Our anesthesia team includes an attending anesthesiologist and two residents or nurse anesthetists in two separate rooms. The anesthesiologist can observe both rooms from his tablet and can communicate with the physician/nurse inside. He can see both the monitors and the patient and help with decision making and problem solving without the need for constant paging and phone calls.

JBJS: What is the greatest benefit from this technology?

Dr. Schwarzkopf:  I think the greatest benefit is the increased integration of the operating team and the streamlined processes that the technology affords us. We are able to communicate and provide oversight in a whole new way. It decreases traffic in the operating room and increases the speed of communication and care given to the patient.

JBJS: What surprised you the most about your experience with Google Glass?

Dr. Schwarzkopf:  The ability to build a complex control tree, which enables one supervising physician to oversee others in a completely new way. We can now see through other peoples’ eyes and we can help and communicate in real time, without old-fashioned back-and-forth information transfer.

JBJS: By using several pairs of Google Glass simultaneously, you have been able to link surgeons, nurses, and anesthesiologists. What are the most important benefits of that type of teamwork?  What barriers remain to greater collaboration?

Dr. Schwarzkopf:  The ability to pair several glasses together is one of the main advantages of this new technology. We observed greater and more efficient teamwork on all sides—surgical, nursing, and anesthesia. The benefits include decreased OR traffic and cost reduction through reduced procedure times. The ability of a supervisor to see through his trainees’ eyes is priceless. We can now directly control actions beyond our immediate line of sight and we can do it without time-consuming back-and-forth communications. When you can see what your resident sees, the phrase “lost in translation” will no longer be relevant. The main barriers that remain are mostly technical, such as the hands-free or voice-activated ability to control the camera angle and “wink” control of the Glass activity. That’s being worked on as we speak.

JBJS: In honor of the 125th anniversary of JBJS this year, we are interested in what orthopaedists think might be important trends in the future. Looking ahead to the next 20 years or so, what do you think might be three significant advances or changes in orthopaedics?

Dr. Schwarzkopf:  We will see significant changes in the way health care is managed and provided, mostly due to changes in regulation and federal guidelines. Resident education will incorporate more advanced methods to allow residents to improve their proficiency while still abiding by increasingly restrictive work-hour regulations. On the technological side I think we will see much more influence from the “gaming” world, like enhanced/augmented reality technology.

JBJS: Thank you very much, Dr. Schwarzkopf. We wish you continued success with all the innovations taking place at UCI.

JBJS Watches/Warnings Cites Concern About Femoral Neck Fractures in Long-Necked Modular Implants

Modularity in the heads and stems of total hip prostheses has afforded orthopaedic surgeons the ability to intraoperatively adjust version, limb length, and offset in ways that can optimize hip biomechanics. Modular implants have achieved these important objectives in thousands of patients over the last couple of decades. However, the rewards of modularity come with risks—some of them serious. Reports of these risks seem to have become more prevalent in the recent orthopaedic literature.

In this “Watch,” we bring to the attention of the orthopaedic community several femoral neck fractures in patients with implants that had modular head-neck and neck-stem designs. While some of these designs are no longer available from manufacturers, thousands of such devices have already been implanted. This “Watch” encourages surgeons to be wary about one specific aspect of modular hip designs: long femoral necks.

Read more.

 

Orthopaedic Surgeons Strongly Influence Purchases

Although nearly 30% of group orthopaedic practices are now owned by hospitals, the 2013 JBJS Role of the Orthopaedic Surgeon study finds that orthopaedic surgeons still exercise powerful voices when it comes to which products and devices get purchased. The percentage of orthopaedic surgeons claiming influence over purchases has been remarkably stable at greater than 90% for the past two years, and surgeons’ influence continues to extend through most stages of procurement processes. Even surgeons in practices owned by hospitals remain actively involved in procurement, except for supplier price and contract negotiations.

Role of Orthopaedic Surgeon Study-2013

 

Publisher’s Note from Kent Anderson, CEO and Publisher of JBJS

Information is easier to get but seemingly less reliable every day. That’s why quality filters like JBJS are so important. And why we spend so much time and effort deciding what not to publish.

This is one of the great hidden aspects of a strong journal – the material that is deemed unsuitable to publish. These decisions can occur for any number of reasons, but usually these boil down to quality, novelty, or interest.

Quality refers to the kind of study, its power, the strength of its hypothesis and analysis, and the care the authors take to draw conclusions from the data. An underpowered study, a muddy analysis, or extravagant conclusions can independently or in combination scuttle a paper’s chances.

A paper that has novelty breaks new ground. It can be a surprising hypothesis borne out by evidence, a new method for divining previously undetected perspectives on an old problem, or simply a new discovery.

Relevance is another word for interest, and making sure the papers we publish are relevant to the high-powered orthopaedic professionals we reach is a key function of our review process.

Together, filtering for these and other aspects of quality research, from IRB approval to author conflicts to plagiarism, all takes a good deal of expertise and effort. But it’s effort that most readers never see. It is what we publishers call “the cost of rejection,” and it can be a significant expense, especially for highly selective journals.

Last year, we implemented a submission fee to help defray some of the costs of rejection. Since then, we’ve seen our rate of submission decline to about the same level we had in 2010, while the level of evidence of the population of papers has increased. We are getting fewer, better papers. And we’re able to take more care with each one. Overall, while we know this was an unexpected fee for our authors, we feel the benefits have been mutual.

In an age of quantity – more information, more emails, more blog posts, more tweets, more statuses – we continue to believe that quality is a key differentiator. Our commitment is deep and lasting in this area. We hope our efforts are apparent in what we deliver.

Is Your Site Optimized for Mobile Web?

Much controversy exists over mobile app usage. According to a recent survey from Netbiscuits, a mobile software firm, almost 80% of respondents said they would prefer using a mobilized website rather than downloading an app. Only 27% of consumers say they frequently download an app when prompted to do so. Three-fourths said they will not use a brand’s website on a mobile device if it is not optimized for mobile. With 25% of consumers spending about six hours a day on the web through their mobile device, “mobilizing” your website could pay off handsomely. Read more.

Mobile Usage by Physicians Doesn’t Coincide with More Apps Used

Although 74% of doctors are using smartphones for work, app usage isn’t growing very quickly, according to a March 2013 study by Kantar Media. The most common type of app used by doctors on a smartphone (72%) is for diagnostic and clinical-reference purposes, up from 70% in March 2012. Drug and coding reference app usage is also up slightly from 2012 from 61% to 64%. EMR apps are used on smartphones by less than 15% of doctors. Among tablet users, the apps most often used are for medical journals/ newspapers/magazines (73%) followed by diagnostic tools/clinical references (61%), and EMR (49%). Read more here.