Introduction
The treatment of complicated anatomic damages caused by trauma or conjenital deformities is always a challenge for surgeons. Addressing this problem medical information systems (MIS) are currently being used. These systems are designed to automate the management of medical and diagnostic activity of standard health care organisations providing outpatient, inpatient, and other types of health care [1, 2]. According to the developed classification of one of the world's leading research and consulting companies in the field of information technology Gartner Inc. (USA), there are 5 generations of MIS developement (Collector, Archivist, Helper, Colleague and Mentor) [3]. The first generation (Collector) includes disparate systems keeping medical records and capable of collecting the consolidated financial statements without the required level of detail of electronic medical records.The second generation (Documentor) is a more advanced system keeping medical records in the networking of health care institutions, but without the ability to support evidence-based medicine and the accumulation of knowledge. The third generation (Helper) is a patient-centric system of conducting electronic medical records with elements supporting evidence-based medicine and the accumulation of knowledge.The fourth generation (Colleague) includes the third generation capabilities, plus the ability to support decision-making. The developers are beginning to implement the principles of evidence-based medicine. The fifth generation (Mentor) includes the fourth generation capabilities with the addition of functional possibilities in applications to prompt physicians to possible ways of treatment and diagnosis of patients. According to the forecast of Gartner Inc. MIS of the 4th generation should have been implemented and MIS of the 5th generation should have appeared by 2016. In Russia among the most popular preoperative planning systems, which by its functionality are beyond the scope of the requirements imposed on the MIS 1st, 2nd and 3rd generation are: TraumaCAD [4-7], MediCAD (http://www.hectec.de/content/index.php/us), OrthoView [8-10], Sectra AB (http://www.sectra.com/medical/osteoporosis/index.html), Surgimap [11, 12] IMPAX orthopedic instruments (http://www.agfahealthcare.com). The aim of this study is the identification of the key challenges arising during the implementation of the preoperative planning systems in the practice of spine surgeons.
Material and Methods
Design
A sociological research was conducted in the form of full-time survey of 61 spine surgeons practicing in Russia, accounting for about 21% of the total number of such specialists in Russia (according to the official data of the Interregional Association of Spine Surgeons 2016). The VII Congress of the Association of Spine Surgeons (Moscow, May 27, 2016) and Saratov Scientific Research Institute of Traumatology and Orthopedics (Saratov, June 20, 2016) are the venues of the sociological survey.
Subjects
The group of specialists surveyed had a high level of professional and academic qualifications. The majority of respondents (60.7%) have the qualification category of health worker; while experts with the highest category (40.5%) are dominating. 42.6% of the experts have PhD or Doctor of Science (Table 1).
The qualification level in the context of professional experience of experts is underpinned by the length of work experience of the experts: 60.6% of respondents have more than 5 years of total work experience, and 34.4% of the respondents have more than 10 years of total work experience. At the same time 54.1% of the respondents have more than 5 years of experience particularly in the field of spine surgery and 23.0% of respondents have more than 10 years of experience (Table 2).
Table 1. Distribution of respondents on the basis of qualifying category and scientific degree, no. (%)
|
Qualification category |
Scientific degree |
|||||
|
Second |
First |
Higher |
None |
PhD |
DSc |
None |
|
8 (13.1) |
14 (23.0) |
15 (24.6) |
24 (39.3) |
15 (24.6) |
11 (18.0) |
35 (57.4) |
Table 2. Distribution of experts on the basis of general medical training and work experience in spine surgery, no. (%)
|
Period |
up to 5 years |
5-10 years |
10-20 years |
More than 20 years |
Not specified |
|
General experience |
21 (34.4) |
16 (26.2) |
11 (18.0) |
10 (16.4) |
3 (5.4) |
|
Experience in spine surgery |
24 (39.3) |
19 (31.1) |
9 (14.8) |
5 (8.2) |
4 (6.6) |
Questionnaire
A specially designed questionnaire consisted of two thematic parts, dedicated to the problem of medical preoperative planning software (PPS) use while planning surgical intervention on the spinal pelvic complex. The full text of the questionnaire is presented in Appendix 1. The first part included the questions relating to the professional level and employment of experts (work experience, position, qualifications). The second part contained questions related to the relevance of development and use of 5 most famous PPS in Russia to ensure effective surgical correction of pathology of spinal-pelvic complex.
Results
The relevance of establishment, implementation in practice and training of specialists to work with the PPS providing the effective surgical treatment of pathologies spinal-pelvic complex is revealed in the results of the analysis of responses of the respondents to the questions of the second block.
In general, 62.3% of respondents believe that the use of a computer programme PPS in the activities of scientific and medical staff is necessary.In terms of opinion of medical specialists (traumatologists, orthopedists, neurosurgeons), the proportion of professionals who support this thesis makes up 70.3%. However, the revealed theoretical understanding of the relevance is not supported by actual practice. According to the survey, 34.4% of professionals do not use any computer PPS, and yet 21.3% can not name exactly what they use. This actualizes both the development of these computer systems and training.The necessity of creation and implementation of PPS is confirmed by the fact that 68.9% of the surveyed experts participate in the planning and conducting of operations.
The interpretation of the survey results concerning awareness and use of PPS in practice gives extra confirmation to our conclusion about the existing gap between the theoretical knowledge and practice.This conclusion is confirmed by the fact that in average approximetely half of the specialists know about the existence of above-mentioned software systems, but in fact, these systems are used by very few ones (Table 3).
Table 3. Distribution of experts on the basis of awareness and use medical preoperative planning software in practice, no. (%)
|
|
Preoperative planning systems |
||||
|
|
Orthoview |
MediCAD 3D |
Traumacad |
IMPAX OrthopaedicTools |
Surgimap |
|
Known |
23 (37.7) |
28 (45.9) |
17 (27.9) |
11 (18.0) |
17 (27.9) |
|
Used |
7 (11.5) |
8 (13.1) |
5 (8.2) |
4 (6.6) |
4 (6.6) |
Today there is a problem of absence of systematic training of dedicated experts working with specialized software products. According to our data, different kinds of conferences and workshops (62.3%), communication with colleagues (39.3%), acquaintance with scientific publications (37.7%) and obtaining information from the developers (21.3%) are the main sources of information about the use of PPS in spine surgery (Figure 1). Neither of experts surveyed pointed out specialized training courses (modules) as a source of information. This indicates the absence of a priority interest of the main subjects of the turnover of specialized software (developers, distributors, educational and medical institutions, healthcare providers) in the increase of the level of dedicated experts’ professional competence.
Figure 1. Sources of information about specialized PPS (values are presented in percents from number of respondents)
A number of survey questions concerned the disadvantages and risks of known PPS, and the requirements imposed by users to such software products.The ranking analysis of processing of results of the respondents’ answers is presented in Table 4.
able 4. Ranking of disadvantages, risks in the use of existing PPS and requirements to specialized software products
|
Disadvantages |
Risks |
Requirements |
Ranking |
|
The absence of the Russian-language version and the technical documentation |
Providing in accurate information doctor |
The presence of the Russian-language version and the technical documentation |
1 |
|
Absence/irrelevant data base implant |
Incorrect selection of the implant |
Automated recommendations for operation planning |
2 |
|
Uncomfortable/complex user interface |
Technical failure |
The presence of the mobile version |
3 |
|
The complexity of the work instruction |
Insufficient protection of the patient's personal data |
The possibility of designing implants |
4 |
Discussion
The analysis of the presented data allows us to formulate the key problems and possible solutions in the development and implementation of vertebrology PPS in the Russian practice:
- Insufficiency of clinical use of these software systems even in case of awareness of its utulity. On average, no more than 10% of the respondents use PPS in their work despite the fact that 44.7% of the experts know about them. Thus, the development and implementation of PPS for ensuring surgical treatment of pathology of spinal-pelvic complex is believed to be actual by high-qualified specialists (according to the results of our study this opinion is shared by 62.3% of respondents).
- Absence of systematic training of profile experts working with specialized software products. Different kinds of conferences and workshops (62.3%), communication with colleagues (39.3%), acquaintance with scientific publications (37.7%) and obtaining information from the developers (21.3%) are the main sources of information about the use of PPS in spine surgery according to our data. Neither of experts surveyed pointed out specialized training courses (modules) as a source of information. This indicates the absence of a priority interest of the main subjects of the turnover of specialized software (developers, distributors, educational and medical institutions, healthcare providers) in the increase of professional competence level of concerned experts. In this regard, specialized training centers based on specialized universities and research institutes should be established. Both public and private partnership is appropriate to be considered as one of the financial and legal mechanisms. The state, on the one hand, in this mechanism, conveys the right to use a particular object of the state property, and a private organization (the developer), on the other hand, provides as a transfer of innovative practices for medical professionals, and improvement of software products in collaboration with scientists and practitioners.
Nowadays in the relevant domestic and foreign scientific editions there are no sociological reserachs dealing with PPS use in spine surgery. The relevance of the sociological study is caused by the extreme rarity of clinical application of SPP in our country, which is confirmed by single domestic publications [13, 14], while there is a significant number of similar foreign publications, indicating the use of such systems in the US, UK and Germany [4- 12, 15-20].
Conclusion
The provided sociological research revealed the main difficulties of the implementation of SPP in surgical practice. Lack of software products focused on Russia and inappropriate database of implants are the main risk factors of incorrect preoperative planning.
Conflict of interest
Autors have no conflict of interest.
Appendix 1. The sheet-questionnaire for participants (page 1)
Appendix 1. The sheet-questionnaire for participants (page 2)
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Received 28 April 2017, Revised 31 May 2017, Accepted 19 June 2017
© 2017, Fedonnikov A.S., Kovtun A.L., Kossovich L.Y., Kirillova I.V., Kolesnikova A.S., Norkin I.A.
© 2017, Russian Open Medical Journal
Correspondence to Alexander S. Fedonnikov. Address: Scientific and Research Institute of Traumatology, Orthopedics and Neurosurgery, Saratov State Medical University n.a. V.I. Razumovsky, 148, Chernyshevskogo str., Saratov, 410002, Russia. Phone: +7-905-3682997. E-mail: fedonnikov@mail.ru.
