ABJS Carl T. Brighton Workshop on Health Informatics in Orthopaedic Surgery: Editorial Comment

Abstract

The economic woes of the United States (U.S.) healthcare system have given rise to an unprecedented federal effort to modernize the information systems and promote the adoption of health information technology (HIT). The recent economic stimulus package—the American Recovery and Reinvestment Act of 2009 (ARRA)—has a HIT component (HITECH Act) that will allocate $17 billion in financial incentives intended to persuade doctors and hospitals to adopt meaningful use of an electronic health record (EHR) and $2 billion for support systems and requisite infrastructure [1, 2]. The purpose of the HITECH Act is to encourage health care providers to leverage HIT tools to achieve quality and efficiency goals. Although this primary value proposition for HIT adoption by health care professionals remains a matter of debate, the potential for secondary benefits such as the reuse of clinical data for research and quality improvement is inevitable [8]. The U.S. is not alone in their efforts to adopt HIT. The United Kingdom’s NHS Connecting for Health (http://www.informatics.nhs.uh), Australia’s HealthConnect (www.healthconnect.gov.au) and Canada’s Health Infoway (www.infoway-inforoute.ca) represent three such efforts at different stages of implementation. EHRs, however, are just one of the many tools of health informatics. The tools of informatics encompass clinical guidelines and decision support, formal health languages, information systems (EHRs, PACS, integrated databases and registries) and communication systems (Internet, telemedicine). It is important to remember that these tools are only a means to an end—the delivery of the best possible healthcare. Informatics is the intersection of people, information and technology. Within the field of informatics are several major subcategories, each with their own domain (Fig. 1). Health informatics has been defined broadly as the logic of healthcare [3]. It is a field concerned with the optimal use of information, often aided by technology, to improve individual health, health care, public health, and biomedical research [6]. Fig. 1 Major subcategories of informatics. (Reprinted with courtesy from Hersh W. A stimulus to define informatics and health information technology. BMC Med Inform Decis Mak. 2009;9:24.) Substantial differences have been identified between various clinical fields to justify the creation of areas of “subspecialty” informatics. Certainly there is enough uniqueness in our information needs, those of our patients and the technologies we routinely use to make clinical decisions to warrant the existence of orthopaedic informatics. Orthopaedic informatics is therefore the logic of orthopaedics—the rational study of the way we think about patients: the way we define, select and evolve treatments; how we create, share and apply clinical knowledge; the information needs of our consumers. It is aided by informatics tools to obtain the information we need in the appropriate detail, of the appropriate quality, when we need it, where we need it, to improve the efficiency and effectiveness of patient care, research and education. Informatics skills underpin communicating effectively, structuring information, questioning to find information, searching for knowledge and making decisions. Informatics has been recognized as a core competency for patient-centered care and the requirements of a changing health system [5]. It is important to note that informatics competency is not just computer literacy. Fig. 2 Christian Veillette, MD is shown. The 2009 ABJS Carl T. Brighton Workshop on Health Informatics in Orthopaedic Surgery brought together various stakeholders in health informatics from across the World to present, debate and develop recommendations for advancing the field of orthopaedic informatics. Representatives from health care institutions, surgeons, HIT vendors, researchers, informaticians, regulators and policymakers, and payers participated in the active discussions on the eight major themes covered including (1) patient education and the Internet; (2) Internet-based education and simulation; (3) telemedicine, disparities in utilization, access to information communication technology (ICT); (4) Web 2.0 and publishing; (5) ontologies and search; (6) informatics in orthopaedic training; (7) information systems, databases, registries – aligning data models in orthopaedics; and (8) EHRs in orthopaedics. We asked each of the Workshop participants to provide constructive feedback with the objective to create summary recommendations and answer the three questions originally asked by Dr. Carl Brighton who established these Workshops in 1996: (1) Where are we now? (2) Where do we need to go? and (3) How do we get there?