“Evidence-based medicine in a private practice setting is compelling, but has unique challenges other institutions may not encounter as frequently,” says Scott Trenhaile, MD, an orthopedic surgeon with Rockford (Ill.) Orthopedic Associates. “There are a lot of patients who are treated in private practice settings that aren’t reported on in the studies at larger facilities and that’s an important aspect that we need to consider pushing forward. There’s another side to the story that will contribute significantly.”
Dr. Trenhaile and his colleagues have successfully implemented data collection and analysis at his practice to contribute to evidence-based orthopedics on a large scale. He discusses six ways his practice, and other small orthopedic practices, are able to practice evidence-based orthopedics.
1. Implement an EMR system so physicians only have to input data once. One of the biggest challenges private practice surgeons face when practicing evidence-based medicine is data collection and organization. Surgeons don’t have time to input patient information multiple times into different databases and most practices don’t have the resources necessary to hire another employee for this type of data management. However, implementing electronic medical record systems takes data input from the surgeon and organizes it in several different ways simultaneously. “We record the data like we would in the ordinary, every day process of seeing the patient,” says Dr. Trenhaile. “We collect the data on the front end so it can be extracted later electronically. That’s how private practice practitioners can contribute on a grand scale.”
2. Standardize the data gathering process. Be consistent in how the data is documented and how documentation is processed. Each physician and medical professional should commit to documenting the patient’s information in the same way to avoid double entry and improve efficiencies in the process. “Just by the journey of moving toward tracking quantifiable and structured data — by taking the necessary steps to get us there — we’ve been able to realize these other benefits,” says Dr. Trenhaile. “By standardizing the documentation process, we can share data more easily internally because we are all speaking the same language. This also makes providing the same type of quality care across the board easier.”
3. Learn to look at yourself critically. A fundamental challenge for any orthopedic surgeon is self-evaluation, which is a necessary aspect of analyzing the evidence from your own work. When the data suggests something is wrong, you have to accept that and make a change. “You have to have the confidence to look in the mirror and critically examine your own work and treatment protocols,” says Dr. Trenhaile. “You really have to evaluate these things and see the things you don’t want to see. You have to make some changes in the practice, which will make it better.”
4. Know when you’ve gathered enough data. Many orthopedic surgeons who do keep track of data in their practice have trouble knowing when they’ve gathered enough data to draw a conclusion and make a change in their practice. Orthopedic surgeons often don’t want to be the first or the last physician to implement a major change, rather they want to fall somewhere in between. Consult with other orthopedic surgeons about your data until you are comfortable with understanding a potential change that needs to be made.
5. Gain patient buy-in for reporting on outcomes. While an EMR may ease some of the burden associated with gathering data for the physician, patients must still do extra work to record their outcomes. However, if patients understand how important gathering information can be to providing better care in the future, they are more likely to fill out any additional paperwork. “We have a sign in our lobby that says ‘Pardon our progress,’ which means patients are helping us provide a higher standard of care by answering these questions,” says Dr. Trenhaile. Make sure filling out the forms doesn’t slow patients down or cut the time they have with their physicians. At Rockford Orthopedic Associates, patients can record their outcomes on paper at the clinic or online through the practice’s website.
6. Advertise what you are doing to patients. Beyond the clinical benefits of gathering data for evidence-based orthopedics, practices might experience an increase in patient volume from advertising this unique quality. “When people find out that we are actually grading ourselves and looking into our outcomes, they respect us for looking in the mirror and admire the fact that we are doing this for them,” says Dr. Trenhaile.
Learn more about Rockford Orthopaedic Associates.
Read other coverage on orthopedic and spine evidence-based medicine:
– 6 Ways Evidence-Based Medicine Impacts Orthopedic and Spine Surgery
– AAOS President Dr. Daniel Berry: 4 Thoughts on the Future
– The Year Ahead: 9 Biggest Issues Facing Orthopedic Surgeons in 2011
