7#YgXdNdNdNdNdNd\d\d\d\d\ dfd|d|Bdxd\e6 eVfm*fdNePeV/epfE(fmfmfmfmfmfmfmDon Wiss - (http://www.scoi.com/doctors/daw.htm) Ken Johnson In Memorium This year the HWB Foundation sustained the profoundly tragic and untimely loss of Ken Johnson, an HWB Foundation co-founder, board member, stalwart and close friend. No matter how well you may have known Ken, we all happen to be his guests on this particular occasion. The whole idea of these HWB luncheon sessions - linked to the AAOS Annual Meeting - devoted to the analysis of methods of our research and education - came from Ken. He not only provided the idea but the charisma to draw people together and cash to make it happen. Therefore, in casting about for an appropriate blessing for the occasion consider this: For that which we are about to receive from thy bounty. Through the Lord and Ken Johnson. Amen. Today we are greatly honored to be joined by Dr. Donald Wiss, a highly esteemed colleague. Through similar academic pursuits as an Associate Professor of Orthopaedics at USC and similar experiences in managing major orthopaedic trauma services, Don and Ken came to know each other like brothers. I am very grateful that Don is with us today to lead our remembrance. Wonderful, eloquent, touching, moving and heartfelt tribute. Besides here, today, Ken keeps a presence at the bedside of the severely injured patient as manifested by the restlessness of the orthopaedic surgeon to stabilize the broken bones. Ken and others were able to establish that the early skeletal stabilization of trauma victims provided a five-fold greater chance for survival than those left to lie on their fractures. This often calls for an unsung heroism in the wee small hours of the morning where surgeons like Ken often have their hands deep in wounds full of sharp objects. Transmission of blood borne pathogens like hepatitis and its rare but fatal transformation to hepatocellular carcinoma became an occupational hazard. There is a comparable sacrifice to those made in name of God and country. He provided greater opportunities for the survival of others at the expense of his own. Not long ago, at One Camino Alto, in Placitas, New Mexico, Ken and I were swinging in bosun chairs handily suspended by his son Kevin on the front porch which looked out on the great Sandia Peaks. Before us were huge upended plates of granite spanning eternity or at least geologic eras of millions of years. It was late afternoon. Shadows of thunderheads scrambled over the rock formations like dark goblins. We sat in awe of an unfathomable force which had been brought to bear in the formation of this incomparable panorama. What could be better? "To see what's happening on other side" Ken said quietly. We should rejoice in knowing that from Ken's vantage point, all sides are now visible. Gus Sarmiento We move now from ethereal reflection upon our good friend Ken Johnson to the contemplation of some problems in Cyberspace. As seen from our annual report, http://www.hwbf.org/hwb/am2003/webstat.htm the HWB Foundation is establishing a substantial educational resource for orthopaedic trauma i.e. the Orthopaedic Trauma Associations On-Line Basic Fracture Course. One of Ken Johnsons big HWB contributions was how he helped us to persuade the faculty members of Basic Fracture Course to overcome kodachromic separation anxiety. The objective was to move this instruction beyond the confines of exclusive hotel ballrooms and make it available in any web connected hospital throughout the world - arriving just in time for teachable and crucial clinical moments. One of many who was good enough to lend expertise, valuable teaching materials and their name to this project was Dr. Augusto Sarmiento, a past president of the AAOS, ARTOF and Professor and Chair of Orthopaedics at University of Miami. He is also an HWB Board member. Having thusly submitted his highly valued intellectual property, Dr. Sarmiento joins us today to tell us what happened next. It rated a special interest editorial in last Julys Journal of Orthopaedic Trauma called One Possible Downside of the Information Revolution. NY Times Feb 8 Page 1 Section 3 Money & Business Thousands of Web sites are putting Playboy magazines pictures on the internet free. And Randy Nicolau, the president of Playboy.com, is loving it. Its direct marketing at its finest. He said Let the music industry sue those who share files, and let Hollywood push for tough laws and regulations to curb movie copying. Playboy, like many companies that provide access to virtual flesh and naughtiness, is turning online freeloaders into subscribers by giving away pictures to other sites that in turn drive visitors right back to Playboy.com. Seth Leopold - http://www.orthop.washington.edu/faculty/Leopold Though many modern medical miracles quickly find themselves on the shelves of obsolescence with wonderment as to why doctors and patients ever submitted to them (for as long as they did), most surveys of the literature find a great preponderance of positive reports. Perhaps this can be explained by the great observers of the human condition, Johnny Mercer and Harold Arlen who wrote: You've got to accentuate the positive Eliminate the negative Latch on to the affirmative Don't mess with Mister In-Between You've got to spread joy up to the maximum Bring gloom down to the minimum Have faith or pandemonium is Liable to walk upon the scene Its just our human nature and there is nothing going on more sinister than that or is there? http://www.hwbf.org/ota/am/ota03/otapo/OTP03021.htm At the OTA Poster Exhibits this past year Kubiak, Egol, Koval and Zuckerman noted that Industry is playing an increasing role in the funding of orthopaedic research. They ask does this lead to the suppression of bad news. To help us answer that question, I believe we are most fortunate to have with us today. Seth Leopold Associate Professor of Orthopaedic Surgery at the University of Washington subspecializing in hip and knee reconstructive surgery. A very fertile field of orthopaedics for industrial grants. His UW web page states: His academic interests include unusual sources of bias in the scientific literature which has given rise to an interesting study in CORR last October entitled: Association Between Funding Source and Study Outcome in Orthopaedic Research I am very pleased that he is able to join us and talk about this with us today. Lewis Zirkle - http://www.signsurgery.org It is a great honor to reintroduce Dr. Lewis Zirkle of the Surgical Implant Generating Network (SIGN). I refer you to its extraordinary historical background published on the SIGN web site. http://www.sign-post.org As a US army orthopaedic surgeon in Vietnam, Lewis gave his spare time to the treatment of civilians caught up in the conflict. Since then he has returned repeatedly to South East Asia and many other underserved parts of the world to not only offer assistance to orthopaedic patients and colleagues there, but also to deliver the wherewithal to accomplish that most challenging task. While tending a private practice in Richland, WA,, Lewis and a group of very talented volunteers (such as Randy Huebner, founder of Acumed, who also joins us today) - have established a state-of-the-art CAD-CAM factory. It has a paid staff of13 people. They manufacture FDA-approved surgical implants and instruments. 99.5 percent of these medical devices are donated in far away places at no cost to the patient, hospital or surgeon. SIGN is a non-profit corporation dedicated to creating equality of fracture care throughout the world. SIGN is a humanitarian organization devoted to advocating optimum fracture treatment for all people. Despite the best intentions, the usual questions persist: What are the results? What are the complications? What constitutes appropriate technology for surgical care in infrastructure-poor settings? What constitutes optimum fracture care? To address these and other concerns, Lewis Zirkle has started a web-based database system which has collected over 1600 records. I am delighted that he is back with us today to share his observations thus far. His reason for doing so is stated in a summary of the 2003 Annual SIGN Meeting in Richland, WA where he and Randy Huebner, founder of Acumed (who is with him here today) and others have set up a state-of-theart orthopaedic implant and instrument manufacturing facility. Lewis concludes: "We are putting our energy into helping people help other people. Hopefully this will continue throughout the world and the world will be a better place because of SIGN. This is not because of the individual patients we treat, but because of chain reactions of emotions and caring for each other. Our symbol is a cracked world held together by a nail. As other people join in, hopefully that crack will become smaller as people start to relate to each other - first on an orthopaedic level, then a personal level and then an institutional level which I think will be conducive to a better understanding and contribute to world peace." MARGARET MEADE said "Never doubt that a small group of thoughtful committed people can change the world: indeed it's the only thing that ever has!". It took but one person the son of the lieutenant governor of Maryland to be admitted to RA Cowleys Shock Trauma unit in Baltimore before a whole new statewide EMS system came into being. However that was dependent on a good result. Larry Minear in a book which provides gudelines for US Private Voluntary Organizations entitled "Helping People in an Age of Conflict" has written: "Humanitarian assistance does not become authentic simply by virtue of being called humanitarian. It distinguishes itself instead by its effective and accountable responsiveness to critical human needs, wherever people are suffering." However, the question arises: What will be the result if there are bad outcomes if SIGN or other outreach efforts were to leave a trail of broken implants and pus draining from infected nonunions. To address this and other concerns, Lewis Zirkle has started a web-based database system which has collected over 1600 records. He is back today to share with us what he is learning thus far. It is a great privilege to introduce two most extraordinary contributors to the field of orthopaedic traumatology - , Professors Margaret McQueen and Charles Court-Brown from the New Royal Infirmary of Edinburgh at Little France in Edinburgh, Scotland. The New Royal Infirmary is considered to be one of the finest and most modern orthopaedic trauma units in the world. There, in the setting of a National Health Service Universal single payor Health System, Drs. McQueen and Court-Brown have established the highly sophisticated Scottish Orthopaedic Research Trust Into Trauma AKA SORT-IT which according to the National Charities Database of the UK commands an annual income of 360,000 (or over half a million dollars). It funds research, education and training. Only 8.3% is spent administratively. The highly innovative Trust offers a stock option donation scheme on the London Stock Exchange which has been reviewed by the London Stock Exchange and the Association of British Insurers. To get some sense of the payoff, we click on Publications and go for a huge scroll. Its enough to give you permanent vertical nystagmus and studded throughout are the names Court-Brown and McQueen. The really amazing thing is that they have this all in their head. I kid you not. I refer you to an encyclopedic extemporaneous (without the benefit of slides or notes) defense of tibial intramedullary nailing in the 1999 OTA Specialty Day Debates by Charles Court-Brown against none other than Augusto Sarmiento. It is archived in the educational archives of the OTA and HWB website and it is a classic. I am most grateful that they are here today to explain their system. SORT IT Scottish Database http://www.trauma.co.uk/ http://www.charitiesdirect.com/charity1/ch023741.htm Key Statistics Total Income 0.36m Admin costs as % of Total Expenditure 8.33% Admin costs as % of Total Income 7.04% Total Funds 0.14m Julie Agel Recently, the Orthopaedic Trauma Association has released its web based database. Today, we are most fortunate to have Julie Agel here to demonstrate it to us. Julie is a pre-eminent, award winning orthopaedic researcher. She played a major role in the development of the Musculoskeletal Functional Assessment outomes instrument the defacto standard and leading indicator of the results in orthopaedic trauma and she just recently won the Edwin G. Bovill award for the outstanding scientific paper presented at the Orthopaedic Trauma Association annual meeting (on distal radius fractures percutaneous versus open treatment). She is listed as the research coordinator on the both the orthopaedic departmental web sites of the University of Washington and the University of Minnesota. However, she prefers to keep a low profile. When I wrote to her to say that I could find no specific web page to use to formulate her introduction here, she replied: Bill: I'm not big into publicity - Probably the only relevant thing for this setting is that I sit on the Orthopaedic Trauma Association Coding and Classification committee which is responsible for the development and maintenance of the OTA database. So voila. Without further ado, here is Julie Agel and the OTA database. William Obremskey http://medschool.mc.vanderbilt.edu/facultydata/php_files/show_faculty.php?id3=9167 http://www.privacyrights.org/ar/HIPAA-Reading.htm http://www.socra.org/HIPAA_Privacy_Rule_030404.pdf We have just seen a number of interesting clinical databases, Every clinical database system presented at the HWB Meeting prompts the question What about HIPAA?. Everybody usually shrugs their shoulders. Although almost everybody knows that HIPAA stands for The Health Insurance Portability and Accountability Act of 1996) designed to protect patient privacy very few can write up a simple HIPAA compliant consent form. HIPAA is a major speed-bump for clinical research. Some of its interpretations threaten to collect more data on the investigators than the investigated. Written one way by the Clintons and then another by the Bushes, the HIPAA privacy regulations are so confusing they have become the biggest consulting bonanza since the Y2K scam/scare. Early versions of the rules required a patient signature stating that they understood what they were signing. In the final versions of the rules, patients only had to sign that they had been given a HIPAA notice of their rights. If they refused to sign, they would not be treated. They have to sign. What is the good of signing something you dont understand? What rights do you have if those rights are not understood? On the OTA Mailing List, Dr. Bill Obremskey, our next speaker, raised the question: What about HIPAA and clinical databases? There were no replies. Bill is a dedicated orthopaedic trauma surgeon and researcher from Vanderbilt who has co-authored with Marc Swiontkowski, a definitive chapter on the conduct orthopaedic research in Skeletal Trauma. He has a Masters Degree of Public Health and substantial public policy experience in the preparation and presentation to the Washington State Legislature of recommendations and a proposal for a state-wide Trauma Registry. I am very pleased that he is with us today to discuss the impact of HIPAA on clinical research. *** from The Society of Clinical Research Associates (SoCRA Source - May 2003) - With respect to the maintenance of a clinical database - The Privacy Rule permits covered entities to conduct some activities that are preparatory to research. For example, researchers who are part of a covered entity can look through that covered entitys database to see if there is an adequate patient population for a study and to contact the individuals in the database. *** from a HIPAA consent form Notice of Privacy Practices for the Horizon Family Medical Group: We value our patients and the various rights afforded to them under federal and state law to access health information. To that end, we recognize and will accommodate patients rights to restrict the disclosure of health information, if we agree to such restriction. In the event there are issues or problems regarding the way your health information was handled by us, you may submit them to us in writing or to the Secretary of the Department of Health and Human Services in Washington, D.C.. You will not be retaliated against in any manner for raising any issues. Ian Alexander -- http://www.orthostar.com/ The highly mobile PDA - Personal Digital Assistant (e.g. Palm Pilot or Pocket PC) - is reckoned by many to be the missing link to the ever-elusive implementation of the complete electronic medical record. A physician resource questionnaire conducted by the Canadian Medical Association last October reported more than 1/3 physicians use a PDA. More than 1/2 physicians under the age of 35 use a PDA. This is a 73% increase since 2001. Despite a lack of infrastructure, office networks, connectivity standards, device shortcomings (e.g. short battery life, small screen, difficult input, fragility and lose-ability) Managed Care Magazine reported a 35% PDA ownership by US physicians last year. We are most fortunate to have Dr. Ian Alexander joining us today to advise on all matters pertaining to PDAs. Ian Alexander is a well published, academic orthopaedic foot and ankle specialist on the teaching staff of the Summa Health System in Akron, OH. There, he has pioneered the development of OrthoStar system, the official AAOS PDA-based clinical documentation and practice management instrument. I am also pleased that Allison Beatty, a clincal researcher from Vanderbilt is here. Allison reported to us last year on the use of PDAs for a clinical research at Vanderbilt with Dr. Kurt Spindler as part of a new AAOS Multicenter Orthopaedic Outcomes Network (aka MOON). I thank both Alison and Ian for being with us today for more insights on the application of mobile computing technology to clinical practice and research. PDA concerns - Processing power, memory, display size, bandwidth, and input mechanisms are limited. Physician PDA Use and the HIPAA Privacy Rule Pancoast et al., AMIA 2003 University of Missouri-Columbia Disruptions in information availability can be a proximate cause in medical errors. However, increased availability of patient information must not jeopardize patient privacy. See: http://www.sans.org/rr/pdas/health_care.php. There is a 30% loss rate of PDA's. Robbers net about $85 per holdup and are caught 80% of the time. Identity and information thieves net about $800,000 per incident and are caught 2% of the time. Scenario. A physician in a group practice attends patients at several hospitals. She downloads new patient data into her PDA at one hospital during rounds and again at a second hospital. Later, during office hours, she receives a call requesting patient orders. After consulting her PDA, she issues the appropriate orders. Her PDA contains data from three different covered entities: two hospitals and her own office practice. Hospital Concerns. Hospitals have concerns about the confidentiality of information given to physicians. Another concern is the individuals right to inspect, copy, and see who has accessed the designated record set. There are several precautions that should be taken by every health care provider who has patient information on a portable electronic device: Maintain careful physical control of the device at all times Use data encryption technology Use antivirus software to prevent spread to desktopds with hot-synching Power-on strong password protection Consider using PDAbomb which wipes the hard drive after 3-4 failed login attempts Disable IR ports except during use Dont send IR transmissions in public It is now my privilege and pleasure to introduce Michael P. Dohm, MD http://www.rmodocs.com/dohm.htm http://www.wssgco.com/history.html from the Rocky Mountain Orthopaedic Associates Grand Junction, Colorado, protg and disciple of Robert Keller (founder and first chairman of the AAOS Outcomes Committee). Mike is a founding member of the AAOS Orthopaedic Outcomes Society and the AAOS Evidence Based Practice Committee. He also founded the Western Slope Study Group(WSSG)in 1997 as a multidisciplinary not-for-profit corporation dedicated to musculoskeletal education and research. Recognizing that ones own experience can be ones best teacher, education occurs through review of research findings, reflection on clinical practice, involvement in clinical outcomes studies, delineating performance benchmarks from study results, and disseminating evidence-based practice guidelines to healthcare practitioners. Data collection has expanded, in terms of numbers of physicians participating, various practices involved and patients assessed longitudinally, creating a larger database for drawing comparisons. Data analysis will provide information about functional outcomes, satisfaction, risks and cost effectiveness of treatments for healthcare providers, insurance payors, and, above all, patients. He is here to talk about an excellent session scheduled as part of this AAOS Meeting. tommorrow Friday March 12 10:30-12:30 Moscone Room 3015-3018 Outcomes and Incomes:Clinical Application of Evidence-Based Practice (U) Moderator: Michael J. Goldberg, MD, Boston, MA The purpose of this symposium is to educate the clinician on the importance of an evidence-based approach to clinical practice. This symposium will provide current clinical applications of evidence in practice and help the clinician understand the use of outcome instruments, application of performance measures, and utilization of a clinical reasoning cycle in the pursuit of best practice. I. Introduction and Opening Remarks Michael J. Goldberg, MD, Boston, MA II. Total Joint Registries: A Current Perspective RobertB. Bourne, MD, London, ON, Canada III. MODEMS: Lessons Learned and Implications for aTotal Joint Registry Khaled J. Saleh, MD, Minneapolis, MN IV. Applications of Current Best Literature in Practice V. James G. Wright, MD, Toronto, ON, Canada VI. Spine Outcome Research Trial: A Successful Outcome Project William A. Abdu, MD, Lebanon, NH VII. Application ofEBP in a Community Setting Michael P. Dohm, MD, Grand Junction, CO  0 DEUor)J)M00J0L0005556K6L6}6~66BdBfBxBBC_CaHOOOOPPQAQBUUUUXXYYYYYYYYZ @ ,B 8$4G23MN#$EF " # L M o p g h OPwxyz{ABi-LMCDEpqr  @ rrWrJKPQ I J!!!">"?$$%Q%R&@&A&&''(()J)K)L)M**+e+f++-<-=../////000K0L0[0o000000000445555556L6~668\8]99;X;Y===>>??@(@)A5A6BcBd aBdBeBfBBC`CaDHDIELEMEEFFHHHI#I$I?I_I`IJJJDJgJKK LLMMNNNIN]N~NNOBOgOOOOOOOOOPPPMPhPQAQBQQS4S5TTUUUSUTUUUUWhWiWWWX#XXYYYYY 0 VlogoBody Text Indent PXZZ.rBdY/01U    #/-/7?HH(FG(HH(d'`=/ BNew YorkTimesCourierArialP _Hlt65729882 _Hlt65562863 _Hlt65404033 _Hlt65633070 _Hlt65389686 _Hlt65389720$ /5NO X% /6NO XC;C;C;PEmcThis year we lost Ken Johnson, an HWB Foundation stalwart, co-founder, board member and good friendwdb