A Farewell to Forms
Posted: 07.01.05 - By Alex French

Stand up straight and take notice: The National Spine Network (also known as the NSN), an integrated spine registry and clinical network organized for the purpose of improving the quality, cost effectiveness and consistency of care for spinal cord injury patients, has enhanced the productivity of spine care professionals by developing and employing technology that aids in the evaluation, management and documentation of those patients.

The NSN’s members are massive, research-oriented practices. In 1998, four years after its founding, the NSN began developing SpinalChart, a software application that is deployed over Fujitsu’s ST5000 series Tablet PC. SpinalChart automates the new patient interview process, collecting all of the information that was previously gathered on paper patient-intake forms during preliminary examinations.

Here’s how the system works: The moment a new patient walks into one of the 28 practices now using SpinalChart, he or she is handed a Fujitsu Tablet PC and instructed to answer questions about their chief complaint, give his or her history of illnesses, symptoms and maladies and answer a handful of other questions. The interview generally takes between 20 and 30 minutes, and patients are not given any kind of training with the tablet, as SpinalChart is entirely self-explanatory—the user is guided through each step of the interview.

According to Harry Freedman, executive director of the NSN, “We’ve been remarkably successful with the tablet PCs, even with the elderly. It’s actually easier [for them] to use than the paper forms. You’ve got a larger font size on the screen, larger buttons.” He continues, “We selected tablets rather than laptops or PDAs because they provided the best ease of use, especially for untrained users. Touchscreens and tablets have been marketed to trained professionals, and the difference in our application is that we are using them with untrained people, basically customers—patients. PDAs and laptops are not alternatives with untrained users.”

The interview gives the treatment center a comprehensive and consistent patient report, even before the doctor sees the patient. According to Freedman, this aspect of SpinalChart has made patients very happy. “We’ve been getting some very positive feedback from patients. They get to spend more time with the doctor, discussing the specifics of their problem, because all of the basic questions have been answered before they see the doctor. The result is that the patient gets more comprehensive care. The quality of care is improved because the physician can ask about related health problems that might not otherwise have been covered. The great example is that we can now screen for such things as osteoporosis, even though that’s not the problem the patient has come in for.”

Once the patient has completed the interview, the responses are wirelessly routed over an office-wide WLAN to a desktop or stand-alone server in the doctor’s office, where the data gleaned from patients’ responses are compiled over the Web and submitted to NSN’s national database. And when interviewing established patients, SpineChart culls patient and clinical data collected during previous encounters to produce a patient report summarizing the patient’s previous treatment plan, noting any trends in their health along the way.

The program was developed and written by four of the five NSN employees in 1998. Dr. Scott Boden, NSN’s chairman and director of the Emory Spine Center in Atlanta, and his colleagues began using SpinalChart in 1998, on the very day it was released. The program was first employed on desktop computers, but in 2002, when tablet technology became available, NSN made the switch.

One issue, says Boden, is the lack of IT expertise in the average doctor’s office. “We had to make the installation and operation very simple and refine it over time, since they have no expertise.” It speaks well for mobile technology, says Boden, that you can install the solution in an office without an IT person, and it can be maintained online by NSN.

Even still, since its inception, the project has hit a few rough spots. Durability, for instance, has proven to be an issue. Elderly patients have displayed a certain tendency to drop the tablets, and the NSN has simply had to absorb the cost of the lost units. Another challenge was that at one NSN practice, the PC server was situated in a room with lead-lined walls, making WLAN signals unreliable.

Over time, however, the tablet PC/SpineCare combination has gained acceptance as the in-house technology has improved, systems have become easier to install and maintain. Doctors are also recognizing the benefits of SpineCare and the tablet PCs. “I’ve used SpineChart for . . . years and have not used a medical transcription service since the first day,” says Boden. “At the end of clinic, my office notes, letters to referring physicians and pre-operative H+P notes are instantly ready, which facilitates referrals and pre-certification of procedures. As a bonus, outcomes to date are collected on all of my surgical patients automatically.”

The reduction in transcription services is a boon to office managers as well; with SpinalChart, physician’s office notes and a letter to the referring physician are produced automatically, which has translated to a savings of $15,000 to $30,000 in transcription fees per physician per year.

The value of this system is being recognized by those outside of the organization as well. Over the past year NSN received a grant from Medtronic Sofamor Danek, a company dedicated to developing new products to aid spinal and cranial surgeons and to expand the distribution and usage of SpinalChart among all spine care providers. As a result, the NSN is currently expanding the SpinalChart concept to all orthopedic patients. Freedman adds, “We’re also interested in helping other medical specialties develop similar software products that can use modern information technology to improve physician productivity and patient care.”•


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