The current environment for the practice of medicine is challenging. Managed care mandates; reductions in Medicare reimbursement; legislation such as the Balanced Budget Act of 1997, the Emergency Medical Treatment and Labor Act, the Health Insurance Portability and Accountability Act; and other factors have led to an urgent need for reducing the cost of healthcare while improving its safety. At the same time, young neurosurgeons in training need more specialized instruction in the increasingly specialized techniques of our profession. Most neurosurgeons need help in better managing their time, quickly accessing patient information and radiological studies, and maintaining patient records for ready access-all while maintaining compliance with various guidelines and mandates.
While information technology does not represent a universal panacea for the ills of medicine, many of its applications hold promise for helping neurosurgeons manage various challenges related to medical practice. This issue of the Bulletin addresses some of the ways in which technology has impacted the practice of neurosurgery, with emphasis on the tools that can be used to help manage our practices or simply keep us better organized.
The New Computers
Ten years ago desktop and laptop computers were mostly used for preparing letters or reports, and they were sometimes tied to local area networks to access data. The new computers now available at low cost are powerful tools that allow data manipulation, three-dimensional imaging, and routine connection to a worldwide network.
The new computers are making inroads within hospitals. Reviewing radiographic images on computer systems such as PACS is now commonplace in many facilities. Computer-based medical records are becoming more sophisticated and more useful. Computerized physician order entry systems have been shown to decrease medication errors by more than 80 percent; in addition, they have resulted in a significant cost savings for hospitals. With correct password and access permissions, a physician can access a patient’s medical record from any site within the treatment facility. In some cases these records even are accessible off site.
The increasing power of the new microprocessors and software applications now is available in handheld computers, the use of which has become second nature to many physicians in their practices. See Typical Day With a PDA in this issue. The fusion of the handhelds to cell phones and more recently to digital cameras, presages a new era in information management.
Of course, before anyone can have access to data, it first must be entered. The laptop computer increasingly is being seen within the clinic exam room itself. With a little practice, it becomes a simple matter to add data as the patient is responding to questions by typing or, following the visit, by voice-activated data entry. In addition, the marketplace provides touch-screen programs on specific disorders such as low back pain, which can readily capture data, create a final report, and also determine the appropriate code for the visit. Handwritten notes and orders and their likelihood of errors soon will not be tolerated.
Digital Tools for Education
Personal computer tools have moved beyond word processing and spreadsheet applications. Software such as PowerPoint, the standard in presentation software, is a powerful tool for education and for presenting the message of neurosurgery to the community. The accessibility of digital cameras and desktop scanners easily allows incorporation of images into educational presentations that can be updated at the last minute and which can be stored-with appropriate backup-in a laptop computer that can travel with you. Increasingly, neurosurgeons are incorporating video into their presentations, introducing a whole new dimension for educating young neurosurgeons in specialized techniques. See The Neurosurgeon as the Compplete Digital Imager and PowerPoint: Great Content Deserves Great Design in this issue.
Digital Tools for Communication
E-mail has taken its place among the major transforming computer technologies because it allows physicians to rapidly communicate with each other regarding patients, in particular those with complex problems. Hospitals and academic centers use e-mail to update physicians on policies and announcements.
However, of concern is the overwhelming volume of e-mail messages in general and in particular the amount of junk e-mail most users receive. Security of e-mail systems in this age of hackers and HIPAA also is of concern. See E-mail Between Colleagues: Promises and Pitfalls in this issue.)
Another factor that impacts the utility of e-mail is that the immediacy of the form suggests urgency. A response to even the most mundane inquiry is expected immediately. Physicians who routinely communicate with patients via e-mail quickly find that they need to develop policies and a system to keep the load from becoming overwhelming. See E-mail Communication With Patients in this issue.
The unprecedented access to information that was driven by the Internet has had an empowering effect on patients who routinely search the Web for information on disorders, treatments, and physicians. Recognizing the need for a Web presence, many neurosurgeons have created their own Web sites as informational, marketing, and increasingly, interactive tools. See Web Site 101 in this issue.
Can Computer Technology Make a Difference?
The nature of neurosurgical practice is being transformed by these new computer technologies. But to be truly useful, these new tools must make a difference. For insight into how a particular tool can be chosen to benefit your practice, see Practice Management Software: Promise or Peril? in this issue.
It is up to neurosurgeons to share their computer technology experiences with others through the AANS Bulletin, [email protected]. It is only through collaboration that we can use the new tools available to us to move our profession forward.
John Oró, MD, professor of neurosurgery at the University of Missouri-Columbia, is chair of the AANS Digital Technology Committee, and a member of the AANS Board of Directors.