Development and Implementation of a Health Informatics Outcome System in Orthopaedic Surgery

Project Details


Background: Musculoskeletal injuries (MSI) are the leading cause of disability in the U.S. Military, resulting in 21,000 shoulder and knee surgical procedures performed annually. Despite the burden of these MSIs to the U.S. Military, there is no system in place within the Defense Health Agency (DHA) to evaluate the outcomes of these most common and disabling conditions affecting Service members. Without such information, military healthcare providers are unable to counsel Service members on expected outcomes, likelihood of return to duty (RTD) and long-term disability, and military leaders are unable to accurately assess operational readiness. This study seeks to address gaps is the areas of tele-administered musculoskeletal outcomes and clinical health informatics integration to provide a DHA-wide enterprise solution for musculoskeletal outcome evaluation.

Objective: The objective of this study is to develop, validate, and determine the effectiveness (compliance rate and patient satisfaction) of a multi-center, integrated, web-based outcome assessment application used to evaluate postoperative shoulder and knee stabilization surgeries. We hypothesize that an integrated outcomes system can be established across multiple centers, and that the compliance rate and patient satisfaction with standardized tele-administered patient reported outcome questionnaires will be high.

Specific Aims: (1) Implement an integrated outcomes delivery system and data repository using SOCRATES standardized questionnaires on a military information technology platform (HERMES). (2) Facilitate expansion, and correlate compliance rates and patient satisfaction with patient-reported outcomes, of tele-orthopaedic consultations. (3) Create a multi-center repository for post-surgical outcomes evaluation of shoulder and knee injuries.

Study Design: A Tri-Service orthopaedic research network will be established to collaborate using a standardized, web-based, HIPAA (Health Information Portability and Accountability Act) compliant clinical assessment and tele-health consultation tool. Validated patient reported outcomes (PRO) measures will be collected to prospectively record baseline and outcome data. Active duty Service members receiving treatment for shoulder and knee instability injuries will be enrolled and validated general and site-specific PRO will be obtained at the time of presentation and at established post-intervention intervals. Demographic, injury, and treatment-related information will be collected and medical readiness will be assessed by evaluation of RTD. Patients and clinicians/researchers will determine the effectiveness of the integrated, web-based outcome tool as measured by the compliance rate and patient/clinician satisfaction with the survey system.

Relevance: MSIs erode combat readiness more than any other single disease or health condition, and cost the DHA more than $500 million annually. Current musculoskeletal outcomes tracking systems in the DHA are fragmented, characterized by burdensome and time-consuming patient interfaces, and lack an integrated system for tracking outcomes across multiple centers. Given the unique demands placed on the military population, there is a significant necessity for development of a robust analytical outcomes tracking tool to assist in the development of specific clinical practice guidelines for the treatment of active duty Service members. The proposed study would directly impact the care of Service members by creating a model for outcomes evaluation that would make possible the validation of evidenced-based injury-specific metrics following surgical stabilization of shoulder and knee injuries. The musculoskeletal outcomes application developed in this study would offer a translatable model to enhance research capability across multiple specialties within the DHA.

Effective start/end date30/10/1530/09/18


  • Congressionally Directed Medical Research Programs: $1,028,500.00


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