How health IT will affect spine surgery in 2019


Ten spine and neurosurgeons weigh on the latest trends in health IT.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What do you think about consolidation in healthcare and how will it affect spine surgeons over the next two to three years?

Please send responses to Anuja Vaidya at by Wednesday, Feb. 27, at 5 p.m. CST.

Question: What health IT innovations should spine surgeons keep an eye out for in 2019?

Jason Liauw, MD. Medical Director at MemorialCare Neuroscience Institute at Saddleback Medical Center (Laguna Hills, Calif.): Regarding IT health innovations, there are some BrainLab tumor mapping technologies that allow us to intraoperatively mark areas of concern, whether that be for brain tumors or spine tumors. This allows for intraoperative communication with radiation oncologists. As such, intraoperative findings can help with post-surgical radiation delivery. New technological platforms such as this that utilize computer-guided navigation platform are not only helping make surgeries more precise but are empowering the continuity of care of oncological treatment from the operating room to postoperative radiation therapy.

Azadeh Farin, MD. Neurosurgeon and Spine Surgeon at Long Beach (Calif.) Medical Center: Health IT innovations will continue to prioritize cybersecurity and privacy. Simultaneously, health IT is being groomed to enhance the patient experience and strengthen patient engagement in, and responsibility and accountability for, one's own health. Health IT has had to satisfy patients' demands for quick access to their medical results, all while ensuring results are securely stored. Leading technology companies can be expected to continue to bridge the interface between machines and people, allowing patients to monitor the pulse of their own health. The various healthcare entities are also cooperating in sharing patient data to a greater extent. This is enormously helpful in optimizing care for patients who have the choice of obtaining various aspects of their care from different entities.

Particularly in spine surgery, payers are looking to reward good outcomes and penalize others. Data is being collected and organized by artificial intelligence systems to determine which patient groups do best with particular interventions. The goal is to use data to draw conclusions that contribute to evidence-based medicine and transform care, helping to ensure greater value and better outcomes with reduced overall cost. The trend is to use technology to influence physician decision-making, improve clinical outcomes and stabilize institutional finances.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Much of what is on the horizon is in regard to artificial reality and virtual reality. Coupled with robotics, we will see what happens, but I think we are on the horizon of a very different way of learning and practicing our specialty.

Vivek Ramakrishnan, DO. Neurosurgeon at Advanced Neurosurgery Associates (Rutherford, N.J.): I am most excited to see the expansion of robotic guidance tools in 2019. While the idea of robotic guidance is certainly not new, the interfaces, machinery and overall surgeon experience have greatly improved in the last year and certainly will continue to flourish this year. We have seen various companies come out with their own versions of robotic-spine tools, and I would expect that to increase this year.

I am also looking forward to how robotic spine surgery ties in with a stronger push for surgeons and OR staff to make the long-overdue effort to try and reduce X-ray load on patients as well as themselves. New 3D navigation, coupled with decreased radiation and improved instrumentation placement with the help of robotics, is most definitely the future of spine surgery and makes me excited about the upcoming year!

Howard An, MD. Spine Surgeon at Midwest Orthopaedics at Rush and Director of the Spine Fellowship Program at Rush University Medical Center (Chicago): There are a number of health IT innovations in development that are incremental or disruptive in nature. The spine surgeons should be kept up-to-date on these developments to serve patients more effectively and to decrease the cost of healthcare. For example, the incremental innovations could be implementing or improving EMR, organizational innovation to improve privacy and security around technology platforms, and innovative desktop or mobile software programs.

Disruptive IT innovations could be artificial intelligence, machine learning, perioperative planning and intraoperative robotic surgery, telemedicine, etc. Some of these "disruptive" innovations are already in use by some spine surgeons, but they are mostly in the early stages of development. The spine surgeons can help treat patients better and more cost-effectively by adopting these technological innovations that are in use or will be in the near future.

Saad Chaudhary, MD. Orthopedic Spine Surgeon at Mount Sinai Health System (New York City): Health information technology is going to pave the future for medical care. Several IT initiatives have been taking shape with regard to spine care. A combination of navigation and robotic technologies are already available to enhance accuracy and reproducibility in surgical outcomes. In 2019, I expect more surgeons to be utilizing surgical planning software and applications (readily available on a computer or a mobile device) on a more regular basis.

These IT applications can facilitate a speedy and real-time analysis of patients' spino-pelvic parameters and global alignment, which can impact the scope of surgical treatment. Other IT initiatives that can help shape spine care in the future include the use of large data analysis with machine learning. These and other IT initiatives will allow for a more uniform approach to spinal pathology and an ability to keep track of patient outcomes.

Betsy Grunch, MD. Neurosurgeon at Longstreet Clinic Neurosurgery (Gainesville, Ga.): Relying on archaic methods like text to coordinate a case is very frustrating and time consuming. Each schedule change or case update requires another round of texts, and the opportunity to forget someone. Surgery coordination technology solves these issues by providing a single hub for case members to store and access all case information. Applications like Casetabs allow imaging and other patient-specific data to be easily uploaded from a mobile device and securely added to the case so that it is readily available for everyone to look at. The ability to access the application via iPhone and Android devices enables surgeons and team members to stay current regardless of location. It's a much more organized, reliable way to coordinate cases.

Philip Schneider, MD. Vice President of The Centers for Advanced Orthopaedics (Bethesda, Md.): Historically, spine surgeons have been assessed on unfair measurements based on the type of care they provide. Innovations in health IT will seek to improve the way we measure the quality of care spine surgeons provide their patients. Standards were previously tailored to that of primary care doctors, and surgeons were assessed on things like whether they took a patient's weight or asked if they were smoking. In 2019 and beyond, the system will offer new quality measures based on patient outcomes and will more accurately reflect spine care.

New health IT innovations will be implemented in 2019 and 2020 to better measure cost as well. Episode cost measures for lumbar spine fusions for degenerative disease one-to-three levels will provide standards for cost, relative to the surgery itself, as well as hospitalization and any complications. This initiative has been advocated for by spine surgeons for quite some time and will finally be implemented.

Gregory Lopez, MD. Assistant Professor in the Department of Orthopaedic Surgery, Division of Spine Surgery at Rush University Medical Center (Chicago): Health innovations in spine surgery are continuing to emerge both on the clinical and surgical side. With regard to surgical innovations, further image-guided technology with robotic assistance is becoming more prevalent in degenerative spine operations. Currently, robotic assistance is limited to pedicle screw trajectory and insertion, however further advances will help aid with other portions of the procedure such as bone manipulation and discectomy.

Advanced intraoperative imaging has also decreased surgeon radiation exposure during minimally invasive spine surgery. Finally, nerve identification is important with lateral-based approaches however, visual identification usually does not occur. New imaging modalities will soon allow for visual identification of important structures hopefully decreasing approach-based complications.

Michael Oberlander, MD. Founder and CMO of Trainer Rx (Walnut Creek, Calif.): An area of health IT innovation to watch is the accelerated integration of open APIs, or application programming interfaces. Now that health systems have automated the health record, the next phase of evolution is connecting all the information via open APIs to improve clinical interoperability. Platforms with open APIs enable the incorporation of multiple applications to be included in the EMR. With multiple point solutions, physicians and their patients can access their data. This improved transfer of information also helps lead to creation of large databases from which analytics can drive more selective and personalized care.


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