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Publisher’s Note: The Technological Revolution in Publishing

The migration of traditional print businesses into online enterprises has created long-term demands on editorial functions, technology partnerships, and organizational cultures. From major technology firms like Google, Apple, and Facebook to enduring publishing brands like the New York Times, these demands have led to very public struggles over the past months.

This month, JBJS launches redesigned and upgraded Web sites, soon to be followed by a unified tablet app for iOS and Android that will include all JBJS journals (JBJS, JBJS Case Connector, JBJS Essential Surgical Techniques, and JBJS Reviews). Because of this and trends in user preferences, technology is front and center for us.

For scientific, medical, and scholarly publishers, online and digital products have been an increasing focus for more than two decades. But some change comes slowly, especially in the realm of organizational culture. During the print era, once an article was published, the cultural habit was to move on to the next set of articles. This approach allowed for batch work consistently oriented toward what was next.

No longer. With our Twitter feed now topping 10,000 followers, the moment an article is published, entirely new workflows begin– social media, archiving, editorial selections for new products and online marketing, and so forth. These activities change our culture, and require new technologies and new skills.

We also now have to rework our archives on a regular basis. This year, JBJS celebrates its 125th anniversary. While building our new sites, we had to migrate 125 years of articles into new formats, new designs, and new technology infrastructures – a major task that was far more difficult and intricate than moving a dozen shelves of bound volumes from one room to another.

We are busy transforming JBJS into a leading organization for the modern information economy – from our core journals to our online education offerings. While the challenges are real and the changes significant, we love the work, and our talents are sharpened every day.

I hope you enjoy our new Web sites, our new tablet app, and our efforts to bring you the best orthopaedic information in formats you can use.

A Conversation with Orrin Franko, MD

Orrin Franko, MD is a fifth-year orthopaedic surgery resident at University of California, San Diego. He has an interest in researching and promoting the orthopaedic uses of social media and mobile apps. In addition to multiple publications on these subjects, Dr. Franko is the founder and creator of TopOrthoApps.com, a website that reviews mobile apps for orthopaedic surgeons. We appreciate his willingness to answer a few questions for OrthoBuzz.

JBJS: Looking back on this year’s AAOS Annual Meeting in New Orleans, what were some of the highlights for you?

Dr. Franko: I was impressed by the combination of traditional posters, digital videos, and presentations. With regard to mobile technology, I was pleasantly surprised to see such a dramatic increase from just two years ago. This year I saw four posters that developed or validated a smartphone or tablet app for clinical use and patient care, something that I have never seen before. On the exhibit floor, iPads are now a ubiquitous platform for displaying education about products, and many new products integrate wireless capabilities and iPad functionality directly into their use.

JBJS: You presented several times in the Electronic Skills Pavilion at AAOS. Tell us a bit about the sessions and the audience response.

Dr. Franko: The Electronic Skills Pavilion provides a unique presentation opportunity for surgeons to give 45-minute talks on a variety of technology-related topics such as social media, practice websites, search engine optimization, and digital photography and videography. This year, I gave three talks on using mobile apps (iPad and iPhone) for education, patient information, and practice enhancement. The talks were very well attended, which suggests to me that surgeons are eager to learn how to use technology to improve their practice and efficiency.

JBJS: How have you seen the attitudes of orthopaedic surgeons toward mobile technology and apps change over the past 3 years?

Dr. Franko: The past 3 years have shown a clear up-trend in the prevalence and use of apps in hospitals and clinics among both residents and surgeons. This is reflected not only in my personal experience, but also in various studies that have assessed mobile-device usage among all physicians and specifically among orthopaedic surgeons. Using a phone in the hospital is no longer a distraction; it’s a critical educational device.

JBJS: What would you say to orthopaedists who are concerned about HIPAA compliance when using apps?

Dr. Franko: HIPAA will always be a “hot topic” with regard to mobile and wireless devices. This stems from a combination of fear about new technologies that are not well understood, and from the learning curve associated with the introduction of any new technology. First, I would remind everyone that historical medical documentation and care utilized paper charts, standard phone lines, fax machines, and text pagers—none of which are encrypted or HIPAA-compliant. In contrast, mobile devices, text messages, phone calls, and email are much more easily encrypted and protected from data breaches.

Admittedly, these systems are not perfect and never will be. However, if appropriate steps are taken to reduce risks, most hospitals permit the use of all these devices. Generally speaking, surgeons should be aware of patient information that is stored directly on their device versus “in the cloud” (on a remote server at another location). And, if information is stored in the cloud, this should be encrypted at a minimum. I equate the current status of mobile technology for patient care to the off-label use of FDA-approved medical devices: as long as surgeons are aware of how these new technologies work and take measures to protect their patients while working within the restrictions of their hospitals, they should be able to safely implement information technologies that benefit their patients.

JBJS: How do you think JBJS can best address the needs of orthopaedic residents?

Dr. Franko: I think JBJS is taking important steps to address residents’ needs to obtain reliable, peer-reviewed orthopaedic information. As a result of Google, the current generation of residents is accustomed to free, unlimited, and contextually searchable information without delay. This is in stark contrast to searching for archived journal articles on library shelves. By providing fully searchable article titles and full text with the ability to download PDFs for offline viewing, JBJS allows residents to find the information they need when it’s needed. Whether this is provided via a traditional website or via a mobile app is a decision of the journal, but mobile apps have proven to be efficient and reliable tools for journal reading.

(Editor’s note: The recent launch of JBJS Reviews included a free app for use with iOS and Android devices.)

JBJS: What trends in orthopaedics are you most intrigued by?

Dr. Franko: I am most intrigued by the ability to engage patients in the mobile sphere and help them to be participants in their own care. The increase in medical knowledge is true not only for residents and surgeons, but also for patients. Our patients have the ability to learn more about their diseases and potential treatment options than ever before, and they present to our clinics and hospitals with sophisticated questions and expectations about their care. I would like to see technology bridge the gaps between physicians and patients with regard to education and outcomes, while also potentially collecting useful data that can help guide further treatment.

JBJS: Looking ahead to the next 20 years, what three significant advances or changes in orthopaedics do you foresee?

Dr. Franko: While I cannot predict the future, I am hopeful that we will see technology enhance three specific areas of orthopaedic surgery. First, I expect to see drastic changes in resident education that utilize a combination of new technologies to disseminate orthopaedic information. That will include interactive digital journal club discussions, video and web-cast surgical techniques, online board-preparation courses, and curriculum changes that accommodate new work-hour restrictions. Second, I anticipate that medical record digitization will no longer be a burden and will rather demonstrate its potential benefits by improving clinical efficiency, patient safety, and enhancing outcomes research. Third, I am interested in watching the transition to universal healthcare and its impact on healthcare economics and ultimately patient outcomes. This will, in turn, greatly influence practice models and surgeon compensation for my generation of surgeons. That, in turn, will affect the way medical advances are developed and introduced into the field.

JBJS: What is your favorite thing about your profession?

Dr. Franko: The patients. Every day I have the opportunity to help people who are deeply motivated to improve and return to activity, which motivates me to help them in any way possible. My second favorite aspect of my profession is having such diverse and open-minded colleagues who are both exceptional clinicians as well as researchers. As a result, there has been great interest in studying the utility of new technology for the benefit of patient care.

Trends in Social Media Usage among Orthopaedists

In a study by JBJS conducted with orthopaedic surgeons in December 2013, 19% report using Facebook for professional purposes, and 39% report using LinkedIn. Only 8% report using Twitter regularly for professional purposes, and there is no consensus on a single, dominant Twitter feed being followed.

When asked how social media will affect orthopaedic care, surgeons responded with a mixed bag of concerns regarding privacy issues, credibility, and direct-to-consumer marketing. However, 21% predicted that social media will have a positive impact on orthopaedic care, primarily for the patient. As one orthopaedic surgeon put it, “[social media] will be the place patients go for reviews of physicians, or to share info.”

According to Howard J. Luks, MD, it is important to have an online presence to help patients learn more about your practice, your qualifications, and find relevant videos. Beyond mainstream sites like LinkedIn, his recommendations for increasing your online presence include sites such as Doximity, HealthGrades, Vitals, ZocDoc, Yelp, and Google Places for Business.

For more detail on the JBJS technology usage study, watch for information about our upcoming webinar.

Google Glass is Now in Orthopaedics

Earlier this year, Dr. Christopher Kaeding became the first surgeon to use Google Glass during live surgery. He used the new technology to consult remotely with a colleague who, thanks to the head-mounted computer/camera, could see the procedure live from the surgeon’s point of view. Several students at The Ohio State University College of Medicine also watched the successful ACL surgery. Google Glass could conceivably give surgeons the ability to instantly call up radiographs, MRIs, and pathology reports during surgery, while giving a unique perspective of surgical procedures to others in remote locations. A thousand people in the U.S. have been chosen to test Google Glass as a part of Google’s Explorer Program.
Read more here