Four spine surgeons discuss big opportunities in spine innovation and what they need in the future to provide better care.
Question: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?
Responses are lightly edited for clarity and length.
Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): Having improved diagnostic options (functional scanning) and newer ways to determine what disease is clinically significant would be a huge asset. We must continue to emphasis evidence-based outcomes research to maintain viable spine-care delivery. The biggest room for innovation in spine is clinical evaluation.
Roger Hartl, MD. Weill Cornell Medicine (New York City): Biologics are starting to enter the surgical arena, but we are still at the beginning. We need better data that biologics really have an impact on disc regeneration and repair. Many groups are working on this and we will likely have much more and better evidence soon. Also, the advantages of tissue engineering (in addition to just injecting cells) have not been taken advantage of. So far, we just use cells but a combination with tissue engineered materials and strategies for annular repair and disc regeneration may have an additional positive impact.
Khalid Kurtom, MD. University of Maryland Shore Regional Health (Easton, Md.): Development of enhance recovery after surgery. The goals are to reduce length of stay, enhance return to work, reduce narcotics dependence, reduce cost of care and improve overall quality of life and performance metrics
Frank Shen, MD. University of Virginia Health System (Charlottesville, Va.): I think that improved interfaces must be developed between the physician and the patient. For example, currently the EMR acts as a clumsy, and clunky, method for recording and storing medical, social and economic information. Physicians currently must interact both with the patient and the EMR simultaneously. This creates a physician-patient and physician-EMR relationship that is both simultaneous and competing at the same time. The current workaround for this problem is to utilize either third-person scribes or delayed charting, both of which have limitations.
However, we need to develop a different paradigm. One that is more seamless; one where the EMR actually helps to improve and facilitate the interaction and relationship between the physician and the patient. This could be viewed schematically simply as a physician-EMR-patient interface. Whether this is utilizing a handheld iPad, video and audio recording, touchscreen tablets, virtual visits or combinations of all or none of these technologies, it must be realized that medical records are not simply about recording and storing information. A sufficiently advanced medical record should also focus on developing improved techniques for retrieval, sharing and processing of information as well.
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