Published 8/1/2009
Thomas J. Grogan, MD

Rise of the Machines: It’s VHS vs. Betamax again

Electronic health care requires intraoperability

Traditional orthopaedic practice is changing. One area of focus, on both local and national levels, is the move toward an electronic format for medical record keeping.

To date, the true beneficiaries of a change to an electronic medical record (EMR) have primarily been the insurance companies and specific holders of risk. A recent article from the American Family Practice Association notes that for every dollar saved through the implementation of information technology—specifically by using an EMR—91 cents is saved by the holder of risk through decreased duplication of tests, better control of medication use, and potentially fewer medical complications. The medical provider realizes just 9 cents of savings.

This lopsided cost/benefit ratio (because the medical provider incurs substantially greater costs in implementing an EMR system) is one of the primary barriers to developing a digital office in an orthopaedic practice. Probably less than one in seven orthopaedic practices in the country today has a fully integrated EMR, and that number will drop even more if you exclude very large physician group practices, such as Kaiser Permanente or large university systems.

Almost a bright spot
If transitioning to EMRs costs a practice substantially and saves it little, making the move to digital radiography is both economical and profitable. Computerized radiography and, to a lesser extent, direct radiography enable an orthopaedic practice to transform stored X-rays to state-of-the-art format. Additionally, 100 percent of the cost savings (no more storage fees, reduced office supply costs) go directly to the practice.

As practices adopt digital X-ray technology, more companies enter the market to fill the demand. The result is that several types of digital X-ray systems are being adopted by orthopaedic practices across the country.

The only negative is that each of these digital systems comes with proprietary interpretation technology. Although every digital X-ray platform can store images in a general data format known as DICOM, individual systems require that a proprietary operating platform be used to interpret the DICOM data.

If a patient wants to take his or her radiographs to another provider, the patient is given a disc that has both the radiographs and the software necessary to view those images. Imagine three different people, each with a computer from a different manufacturer (such as Dell, IBM, or Apple®) trying to open the same Word document and needing not only the document file, but also the entire operating system of the computer that originated the file!

What a waste of time
It takes, on average, 41 seconds to open a disc containing a patient’s radiographs. Opening just three outside discs a day amounts to a little more than 2 minutes.

Multiplied across the entire orthopaedic work force in the United States (15,000 full-time orthopaedic surgeons in private practice, each working on average 22 days a month, 12 months a year), this translates into 135,250 hours spent simply waiting for the disc to open. If you consider that each surgeon works, on average, 2,080 hours a year, that’s the full-time equivalent of 65 orthopaedic surgeons doing nothing but waiting for radiographs on disc to open.

According to the AAOS Orthopaedic Practice and Medical Income Survey (2007-2008), median gross collections per orthopaedic surgeon are $850,000 annually. Thus, this amounts to a cost of wasted orthopaedic time of $55,250,000 per year—or more than half a billion dollars in wasted time over the course of a decade—time that could have been spent seeing patients.

In the rush to develop information technology, vendors need to make sure that their systems can be interpreted across a wide range of orthopaedic practices and settings. Making data available in a format that best serves the needs of patients must be a primary concern to the vendors of digital products.

Thomas J. Grogan, MD, is a member of the AAOS Practice Management Committee. He can be reached at tjgrogan@aol.com